This systematic review pooled 11 studies and 176,352 shoulders to ask how corticosteroid injections affect rotator cuff repair. It separated preoperative injections from postoperative injections. The question: do steroids given before or after repair increase retear and revision rates?
When a patient needs a rotator cuff repair, count their recent injections and check the timing. The risk is not the steroid itself but dose and proximity to surgery. A single injection more than 6 months out is low risk. Two or more injections in the prior year roughly double to triple revision odds, and an injection within 2 months of surgery is the worst offender.
The mechanism is impaired tendon-to-bone healing: steroids reduce insertion-site blood supply, increase cell death, and weaken the tendon, with animal data showing 4 to 8 weeks minimum to recover. After repair the calculus flips. Injecting several weeks out for a stiff or painful shoulder improved pain and motion without clearly raising retear rates in most studies.
Weigh this evidence carefully: nearly all preoperative data come from insurance databases prone to confounding by tear size and chronicity, and only one postoperative study was a true RCT.
This systematic review pooled 11 studies and 176,352 shoulders to ask how corticosteroid injections affect rotator cuff repair. It separated preoperative injections from postoperative injections. The question: do steroids given before or after repair increase retear and revision rates?
When a patient needs a rotator cuff repair, count their recent injections and check the timing. The risk is not the steroid itself but dose and proximity to surgery. A single injection more than 6 months out is low risk. Two or more injections in the prior year roughly double to triple revision odds, and an injection within 2 months of surgery is the worst offender.
The mechanism is impaired tendon-to-bone healing: steroids reduce insertion-site blood supply, increase cell death, and weaken the tendon, with animal data showing 4 to 8 weeks minimum to recover. After repair the calculus flips. Injecting several weeks out for a stiff or painful shoulder improved pain and motion without clearly raising retear rates in most studies.
Weigh this evidence carefully: nearly all preoperative data come from insurance databases prone to confounding by tear size and chronicity, and only one postoperative study was a true RCT.