Journal Article

Preoperative hyaluronic acid injection modulates postoperative functional outcome in patients undergoing arthroscopic rotator cuff repair

Masafumi Gotoh, Naoto Shiba, Hiroki Ohzono, Yosuke Nakamura, Yasuhiro Mitsui, Takahiro Okawa, Hidehiro Nakamura

2020

Overview

Background Arthroscopic rotator cuff repair (ARCR) generally yields acceptable clinical results. Hyaluronic acid (HA), a high-molecular-weight polysaccharide, is present in the extracellular matrix of soft connective tissue and synovial fluid, and its injection is known to significantly improve pain and clinical outcomes after rotator cuff injury. Some studies have described the role of HA injections as conservative therapy for rotator cuff tears. Since the subacromial bursa is believed to be the main source of shoulder pain in rotator cuff tears, subacromial injection is frequently used before surgery; however, its relationship with the clinical outcome after surgery remains unclarified. Therefore, we aimed to examine effects of preoperative subacromial HA injection on postoperative clinical outcome in patients with ARCR. Methods Ninety-eight patients were divided into a HA injection group and a non-injection group. The functional outcome measured was the University of California, Los Angeles (UCLA) score. Univariate analysis was performed to obtain variables with p values less than 0.1; we then used propensity score analysis, adjusting for pre- and post-operative confounding factors. Results The UCLA scores of all patients significantly improved 1 year postoperatively (PO) ( p < 0.05). Subacromial HA injections were performed in patients with worse preoperative function. Univariate analysis showed significantly greater improvements in the injection group than in the non-injection group in terms of preoperative UCLA score, trauma, diabetes mellitus, UCLA score 3 months PO, abduction strength 4 months PO, and internal rotation (IR) strength 6 and 12 months PO. Propensity score analysis demonstrated that UCLA scores 3 months PO and IR strength 12 months PO in the injection group were significantly greater than those in the non-injection group. There were no significant differences in postoperative re-tear rates between the groups. In sub-analysis of the injection group, propensity scores showed that concurrent use of local anesthetics did not affect the data, suggesting that HA was effective. Conclusion Subacromial injection was administered to patients with worse function before ARCR. Propensity score analysis successfully demonstrated that functional outcome after surgery was improved in patients who were administered this injection compared with patients who were not administered this injection before surgery.

• Publisher: Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Analysis / Anesthetics / Arthroscopic rotator cuff repair / Arthroscopy / Care and treatment / Clinical outcomes / Connective tissues / Cytokines / Diabetes mellitus / Diseases of the musculoskeletal system / Extracellular matrix / Female / Fibroblasts / Functional outcome / Hospitals / Humans / Hyaluronic acid / Hyaluronic Acid - administration & dosage / Injections, Intra-Articular / Local anesthetics / Male / Medicine / Medicine & Public Health / Middle Aged / Nonsteroidal anti-inflammatory drugs / Orthopedic surgery / Orthopedics / Pain / Patient outcomes / Patients / Polysaccharides / Postoperative period / Preoperative Care / Propensity Score / Propensity score analysis / Range of motion / Range of Motion, Articular / RC925-935 / RD701-811 / Recovery of Function / Research Article / Retrospective Studies / Rotator cuff / Rotator Cuff Injuries / Rotator Cuff Injuries - surgery / Rotator cuff repair / Rotator cuff tear / Studies / Subacromial injection / Surgery / Surgical Orthopedics / Synovial fluid / Trauma / Treatment Outcome / Viscosupplements / Viscosupplements - administration & dosage