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This study evaluates the impact of perioperative dexamethasone on pain and functional recovery after rotator cuff repair.

June 10, 2026Open Access

Perioperative Intravenous Dexamethasone Improves Pain and Functional Outcomes After Arthroscopic Rotator Cuff Repair

Key Points

This study evaluates the impact of perioperative dexamethasone on pain and functional recovery after rotator cuff repair.
309 patients who underwent rotator cuff repair were analyzed, divided into dexamethasone and control groups.
Outcomes measured included VAS pain, PROMIS scores, and MCID achievement, using regression models for adjustments.
Subgroup analyses were done based on tear size to assess differential effects.
Patients receiving dexamethasone reported significantly lower VAS pain scores at 12 months (1.9 vs 3.1, P = .003) and 24 months (1.0 vs 1.8, P = .035).
Dexamethasone improved early achievement of MCID in small/medium tears at 6 weeks (31% vs 21%, P = .041) and 3 months (34% vs 21%, P = .012).
No differences in opioid consumption were observed (all P > .12), and complication rates were similar between groups.

Abstract

Purpose To evaluate the effect of perioperative dexamethasone on patient‐reported pain, functional outcomes, and minimal clinically important difference (MCID) achievement following arthroscopic rotator cuff repair. Methods Patients who underwent rotator cuff repair between 2013 and 2023 were identified and divided into groups. Those who received peri operative dexamethasone were compared with controls. Outcomes included visual analog scale (VAS) pain, patient‐reported outcomes measurement information system (PROMIS) upper extremity, PROMIS pain interference, and MCID. Multivariate logistic and linear regression models adjusted for age, sex, body mass index, diabetes, race/ethnicity, smoking, and preoperative opioid use. Subgroup analyses were performed by tear size. Results A total of 309 patients was included (187 dexamethasone and 122 control). Dexamethasone administration was associated with improved functional recovery and sustained pain reduction. PROMIS upper extremity and PROMIS pain interference scores favored Dexamethasone at 6 weeks, 3 months, and 6 months (all P .12). Dexamethasone reduced ondansetron use in large/massive tears at 0‐4 hour (β = −0.34, P = .04) and in small/medium tears at 4‐8 hour (β = −0.19, P = .04), with no differences for other antiemetics. Complication rates were similar (11.2% vs 4.9%, P = .055). Conclusions Perioperative intravenous dexamethasone is a safe adjunct to arthroscopic rotator cuff repair, supporting early antiemetic benefits, durable pain relief, and selective improvements in patient‐reported outcomes. Benefits appear most pronounced in small/medium tears at early follow‐up and large/massive tears at later stages, suggesting tear size‐specific response. Level of Evidence Level III, retrospective comparative study.

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