Summary

Statin do not have any effect on rotator cuff healing or fatty atrophy of cuff muscles after repair.

Abstract

Objectives:
Statin use has been linked to structural and vascular changes in tendon and therefore there are concerns over a higher incidence of re-tear after repair. The objective of our study was to evaluate the effect of statins on rotator cuff healing following repair and also on the progression of fatty atrophy (Goutallier grade).

Methods

A cohort of 77 patients undergoing rotator cuff repair for isolated posterior/superior rotator cuff tear were prospectively evaluated. Pre-operative details such as demographic profile and statin use were collected. Patient reported outcome measure (PROM) scores including Constant score, American shoulder and elbow surgeons (ASES) score and Disability of arm, shoulder and hand (DASH) score were collected preoperatively and at one year. All the patients had MRI pre-operatively and at one year to quantify rotator cuff healing based on the Sugaya classification and Goutallier staging of fatty atrophy. All MRI’s were assessed by a blinded radiologist. Intra-operative details such as cuff tear size, method of repair (single row or double row), and concomitant procedures (biceps tenotomy/tenodesis, acromio-clavicular joint excision) were noted. Statistical analysis was performed with student t-test to assess improvement in PROM score. Spearman correlation test was used to evaluate association of statin with cuff healing and progression in fatty atrophy.

Results

Our study population included 42 males and 35 females with mean age 60.9?7.0 (range 45-76) years. 38 patients had previous history of hyperlipidemia and were on a statin drug. 19 patients had single row and 58 had double row repair. Mean pre and 12-months post-operative PROM scores were 36.2?20.5 and 76.7?23.6 (ASES), 32.8?19.8 and 67.0?20.5 (constant), and 63.0?15.7 and 23.7?22.9 (DASH score) in statin group. Mean pre and 12-months post-operative scores were 38.7?16.3 and 76.9?25.7 (ASES), 34.6?18.6 and 74.8?19.6 (constant), and 58.8?18.7 and 16.2?19.9 (DASH score) in no-statin group. PROM scores improved significantly in both groups (p<0.01). Cuff re-tear was seen in 14 patients [six (15.78%) and eight (20.51%) in statin and no-statin group respectively]. Progression of fatty atrophy was seen in eight patients [four (10.52%) and four (10.25%) in statin and no-statin group respectively]. The rate of cuff re-tear and progression of fatty atrophy was comparable in both groups. Statin use did not correlate significantly with either cuff healing (Ps=0.049, p=0.692) or progression of fatty atrophy (Ps=0.013, p=0.909).

Conclusion

Our result proves that, contrary to previous literature, statin do not have any effect on rotator cuff healing or fatty atrophy of cuff muscles after repair.