Does statin-treated hyperlipidemia affect rotator cuff healing or muscle fatty infiltration after rotator cuff repair?

Abstract

PURPOSE: Hyperlipidemia is linked to poor tendon to bone healing and progression of fatty infiltration after rotator cuff repair. Statins effectively treat hyperlipidemia, but it is unknown if they have any potential detrimental effects following rotator cuff repair. The aim of this study was to evaluate the effect of statins on rotator cuff healing and fatty infiltration following repair. METHODS: A total of 77 patients undergoing arthroscopic rotator cuff repair were recruited prospectively, 38 patients who were prescribed a statin (statin group) for hyperlipidemia and 39 patients not on statin (control group). The patients who did not have both preoperative and one-year postoperative MRI scan were excluded from the study. Patient reported outcome measures, namely the Western Ontario Rotator Cuff index, Constant-Murley score, American Shoulder and Elbow Surgeons score, and Disability of Arm, Shoulder and Hand score were collected preoperatively and at one year. Fatty infiltration was assessed on MRI according to the Goutallier grading preoperatively and at 12 months, rotator cuff healing was assessed at 12 months according to the Sugaya classification. Following propensity score weighting to adjust for baseline imbalances, twelve-month outcomes were compared between the two groups. RESULTS: At 12 months, all patient reported outcome measures had improved significantly compared to baseline (WORC, 85.9 vs 32.5, p<0.001; ASES, 87.3 vs 37.5, p<0.001; Constant, 77 vs 31, p<0.001; DASH, 13.6 vs 61.4, p<0.001). There was no significant difference in postoperative scores between the two groups (WORC, 84.9 vs 89.6, p=0.94; ASES 87.5 vs 86.6, p=0.40; Constant, 77 vs 81, p=0.90; DASH, 14.4 vs 11.4, p=0.14, statin vs control respectively), and in three of these the 95%CIs excluded a clinically meaningful difference. Similarly, rotator cuff healing at 12 months and Goutallier fatty infiltration grades were comparable between the two groups. Retear was seen in six (15.8%) patients in the statin group and eight (20.5%) patients in the control group. Progression of fatty infiltration was seen in four (10.5%) patients in the statin and four (10.3%) in the control group. Statin use did not demonstrate significant association with either retear risk (P = 0.41) or progression of fatty atrophy (P = 0.69). CONCLUSION: Patient-reported outcomes, rotator cuff retear rate and fatty infiltration on MRI at 12 months post rotator cuff repair in patients with hyperlipidemia treated with statins are similar to a control group.