Postoperative angiotensin II receptor blocker use is associated with reduced 2-year reoperation rates in male patients undergoing arthroscopic rotator cuff repair

Background Angiotensin II-Type receptor blockers (ARBs) antagonize the effects of transforming growth factor–β1 (TGF-β1), a cytokine mediator for fibrosis and fatty infiltration in skeletal muscle. The objective of this study was to determine 1.) if postoperative ARB use is associated with reduced rates of secondary surgery two years following arthroscopic rotator cuff repair, and 2.) whether there are differences in these outcomes within male, female and non-sex specific cohorts. Methods The Tri-Net X national database was queried to identify patients between 2015-2022 who were prescribed an ARB (losartan, valsartan or olmesartan) within three months of arthroscopic rotator cuff repair. ARB patients were propensity matched 1:1 with a non-ARB control. Analyses were conducted to assess outcomes differences within male, female, and non-sex specific cohorts. Two year secondary surgery rates (manipulation under anesthesia, revision rotator cuff repair, conversion to reverse or anatomic total shoulder arthroplasty, and non-rotator cuff repair arthroscopic shoulder procedures) were evaluated and compared using odds ratios (OR). Results In total, 2,883 matched ARB and non-ARB rotator cuff repair patients were included, with a mean age of 62.5 years, and 42% female in each cohort. In the non-sex specific analysis, within two years after surgery the non-ARB cohort had similar rates of revision rotator cuff repair as the control. In the female-specific analysis, 1,228 matched ARB and non-ARB females were included with an average age of 63.2, and there were no statistically significant differences in secondary surgery rates. In the male-specific analysis, 1,562 matched males were included with an average of 62. The male non-ARB cohort reported significantly higher rates of undergoing revision rotator cuff repair (OR 1.33, 95% confidence interval (CI) [1.01–1.75], p=0.039) and significantly higher rates of undergoing total non-rotator cuff repair arthroscopic shoulder procedures (OR 1.35, 95% (CI) [1.04–1.75], p=0.025) compared to the ARB male cohort. Conclusion The findings of this study suggest that ARB use may be associated with lower rates of secondary shoulder surgeries in patients undergoing rotator cuff repair, with the effects predominantly observed in male patients.