Key result
Two or more corticosteroid injections before rotator cuff repair could triple the odds of revision, though a cause-and-effect relationship cannot be ascertained due to confounding by indication.
This editorial highlights that while registry data suggests multiple corticosteroid injections before rotator cuff repair may increase revision risk, confounding by indication limits causal conclusions.
Analysis of insurance records indicates that 2 or more corticosteroid injections before rotator cuff repair could triple the odds of revision. The cause-and-effect relationship cannot be ascertained because it remains unclear whether steroids worsen outcomes or are injected in shoulders that are worse to start with. Registry studies cannot adjust for lesional determinants of prognosis and should be interpreted with caution to avoid depriving patients from safe and simple treatments to delay or circumvent surgery. The risks of corticosteroids could be mitigated using radiographically guided infiltration and, ultimately, by rapid surgical repair in young patients before the advent of fatty infiltration and tendon retraction.
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Mo Saffarini (2019) conducted an editorial in Rotator cuff repair. Corticosteroid injections was evaluated on Revision surgery (triple the odds). Two or more corticosteroid injections before rotator cuff repair could triple the odds of revision, though a cause-and-effect relationship cannot be ascertained due to confounding by indication.
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