The Effect of Corticosteroid Injections on Clinical Outcomes and Failure Rates after Rotator Cuff Repair: A Systematic Review

Abstract Purpose To synthesize the clinical outcome data of pre-operative and post-operative corticosteroid injections and their effect on rotator cuff repairs. Methods A systematic review was performed to identify studies that reported the results or clinical outcomes of rotator cuff repairs in patients receiving either preo-perative or post-operative corticosteroid injections. The searches were performed using MEDLINE, Google Scholar, and Embase, and studies were chosen following PRISMA guidelines. Results Eleven studies were included with data for 176,352 shoulders. Six studies involving 175,256 shoulders were included with data regarding pre-operative CIs and four studies involving 1,096 shoulders with data regarding post-operative CIs. One study with 212 shoulders contained pre-operative and post-operative data. Pre-operative CIs were found in three studies to increase the risk of revision surgery when administered within 6 months (OR=1.38-1.82) and up to one year (OR=1.12-1.52) prior to RCR, with revision rates in two studies highest when receiving two or more injections (OR=2.12-3.26) in the year prior. Post-operative CIs reduce pain and improve functional outcomes in five studies without increasing the rate of retear (CI=5.7%-19%; Control=14%-18.4%) in most studies. Conclusion Corticosteroid injections provide benefit by relieving pain and improving functional outcome scores. However, repeated pre-operative CIs may increase retear rates and the likelihood of revision surgery. A lower frequency of CI and longer pre-operative waiting period after CI should be considered to decrease such risks. Post-operative CIs several weeks after RCR do not appear to increase retear rates.