Dyslipidemia With Perioperative Statin Usage Is Not Associated With Poorer 24-Month Functional Outcomes After Arthroscopic Rotator Cuff Surgery

Abstract

Background: Current literature suggests a higher rate of rotator cuff disease development in patients with dyslipidemia (DL). Moderate to high levels of DL are associated with higher rates of retear and revision surgery after arthroscopic rotator cuff repair. Statins protect against development of rotator cuff disease and mitigate the need for rotator cuff repair. Purpose: We aimed to investigate the influence of DL and statin use on postoperative functional outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2010 and 2016, 266 patients underwent arthroscopic double-row rotator cuff repair for atraumatic full-thickness tears. Evaluation was conducted preoperatively and at 3, 6, 12, and 24 months postoperatively. Three functional outcome measures were used (Constant Shoulder Score [CSS], Oxford Shoulder Score [OXF], and University of California, Los Angeles, Shoulder Rating Scale [UCLASS]), as well as a visual analog scale (VAS) for pain. DL and non-DL were classified through screening of health and assessment of lipid levels within 6 months of surgery (triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein). Patients with DL were divided into statin users and nonusers. Types and dosages of statins were recorded, and intensity and equivalency charts were employed for standardization. Mann-Whitney U test and Pearson chi-square test were used for analysis. Generalized estimating equations and linear mixed models were used to examine the influence of DL and statin dosage, respectively on percentage change of postoperative outcome scores. Results: Increased age was associated with a higher incidence of DL ( P < .001), and 86% of the DL group was taking statins. The DL group also exhibited poorer scores preoperatively (CSS, P = .001; OXF, P = .032). No significant difference in scores was elicited between the DL and non-DL groups at 24 months. However, patients with DL experienced greater percentage improvement of CSS and OXF from preoperative baseline than did patients without DL ( P = .008 and P = .034, respectively) at 24 months. There was no significant difference in 24-month functional outcomes between statin users and nonusers. No statistically significant change of CSS; OXF; UCLASS; or VAS was noted with increasing statin doses at 24 months. Conclusion: Patients with DL with perioperative statin usage did not have poorer 24-month functional outcomes after arthroscopic rotator cuff surgery compared with those in patients without DL.

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

“…The clinical outcomes post-surgery were comparable between the two groups, with 95% confidence intervals or "plausible ranges" suggesting that this study excludes any differences larger than the MCID for three of the four outcomes. Our finding of equivalent functional outcomes matches the findings from a recent retrospective study by Zeng et al 41 investigating the outcome of rotator cuff repair in 266 patients with hyperlipidemia treated with statins.…”

Dyslipidemia is associated with risk for rotator cuff repair failure: a systematic review and meta-analysis

“…16 Amit et al 4 showed that patients on statin therapy had fatty infiltration progression, retear rate, and function comparable to non-DLD patients. Similar results for functional outcomes are found in Zheng et al 61 Cancienne et al 11 offer perhaps the most convincing evidence that statins mitigate the risk of retear, given the significant size of study and comparison within groups. In this study, DLD patients had a significantly greater risk of retear without statins, although DLD patients on statins had risk equivalent to non-DLD patients.…”

“…Circulation-derived lipid deposits in tendon extracellular matrix have been widely observed in nonfamilial hypercholesterolemia patients. The present research suggests that these deposits cause oxidative damage, persistent inflammatory cytokine production, obstructed tissue vascularity, 8 Retrospective cohort III ++++ + Satisfactory Cancienne et al, 2017 11 Retrospective cohort III ++++ + +++ Excellent Garcia et al, 2017 23 Retrospective cohort III ++++ ++ Good Harada et al, 2021 25 Retrospective cohort III ++++ +++ Good Kim et al, 2017 31 Retrospective cohort III ++++ ++ ++ Excellent Zheng et al, 2020 61 Retrospective cohort III ++++ ++ Good Jeong et al, 2018 30 Caseecontrol III ++++ + + Good Lee et al, 2020 38 Caseecontrol III +++ + ++ Good O'Donnell et al, 2020 46 Case series IV ++++ + +++ Excellent Park et al, 2020 49 Case series IV ++++ ++ ++ Excellent and reduced cholesterol efflux and matrix turnover by macrophages and tenocytes. 2,5,11,55 In a recent study by Li et al, 39 high cholesterol inhibited gene expression in tendon-derived stem cells, a newly identified resident cell population theorized to be responsible for tendon maintenance and repair.…”

“…In 5 of 5 studies 4,8,23,38,61 recording functional outcomes, there was no significant difference in DLD patients versus non-DLD patients across multiple outcome measures and patient-reported assessments (Table II). Function was recorded postoperatively at 3, 6, 25 12 4,8 , and 24 months.…”

Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

“…6 These findings reiterate that the structural and functional outcomes of patients receiving statin therapy are similar to those of patients who did not need statin therapy. Zeng et al 40 recently showed no significant difference in shoulder functional outcomes 24 months after rotator cuff repair between patients with hyperlipidemia who had statin therapy and patients without hyperlipidemia. A prospective study supported our results that the clinical and structural outcomes of patients with statin-treated hyperlipidemia were similar to those of patients without hyperlipidemia.…”