Abstract
BACKGROUND: Nonoperative management of atraumatic rotator cuff tears often includes corticosteroid injection (CSI). Concerns persist regarding CSI effect on tendon quality and rotator cuff repair (RCR) outcomes, though how timing of a single CSI influences RCR outcomes is unclear. This study evaluated whether CSI timing within 1 year before RCR affects repair failure, patient-reported outcomes (PROs), range of motion (ROM), and strength, compared to patients undergoing RCR without CSI. We hypothesized that CSI within 3 months of RCR would lead to higher failure rates and worse outcomes. METHODS: This retrospective study examined consecutive adult patients undergoing primary RCR from 2015 to 2022 at 1 institution. Inclusion criteria were nonoperative management of an atraumatic rotator cuff tear ≥6 weeks and minimum 1-year follow-up. Exclusion criteria included prior shoulder surgery and traumatic injury. Patients with preoperative CSI were grouped by CSI timing before RCR: <3 months, 3-6 months, and 6 months-1 year. Primary outcome was repair failure (reoperation or magnetic resonance imaging-confirmed retear). Magnetic resonance imaging was performed only in patients with symptoms suggesting recurrent cuff pathology. Secondary outcomes included PROs (Subjective Shoulder Value, Patient-Reported Outcomes Measurement Information System scores, American Shoulder and Elbow Surgeons score, visual analog scale [VAS]), strength, and ROM. RESULTS: Overall, 198 patients were included; 89 patients without preoperative CSI (controls), 44 with CSI within 3 preoperative months, 34 with CSI 3-6 months prior, and 31 with CSI 6-12 months prior. Mean ages were 59 (controls), 59 (CSI <3 months), 63 (CSI 3-6 months), and 57 years (CSI 6-12 months) (P = .13). Demographics, follow-up length, RCR technique, and tendons involved were comparable across groups (all P > .05). Overall repair failure was 24%, with 19% failure in patients who received CSI. Group failure rates were 30% (controls), 20% (<3 months), 18% (3-6 months), and 19% (6 months-1 year) (P = .34). Postoperative improvements were similar between all groups for visual analog scale (3 vs. 4 points, P > .05), Subjective Shoulder Value (21% vs. 29%, P > .05), and American Shoulder and Elbow Surgeons scores (15 vs. 12 points, P > .05). Postoperative external rotation decreased by 4° among all CSI patients (P = .02) but increased by 3° in controls. Postoperative PROs, ROM, and strength were similar between groups. CONCLUSION: This study demonstrated comparable outcomes for patients receiving CSI within 1 year of RCR and control patients. Timing of 1 preoperative CSI within 1 year of RCR did not significantly affect failure, PROs, ROM, or strength, suggesting that 1 CSI before RCR does not strongly influence outcomes.