Perioperative Losartan Is Associated With Similar Rates of Additional Surgical Procedures for Postoperative Shoulder Stiffness After Primary Arthroscopic Rotator Cuff Repair but Lower Rates of Secondary Debridement and Repair

Abstract

Purpose: To compare the rate of additional shoulder surgery related to postoperative stiffness or tendon healing after primary rotator cuff repair between patients with a losartan prescription and without a losartan prescription.

Methods: The International Classification of Diseases, Tenth Revision, code M75.1 was used to identify all patients in the TriNetX Research Network with a rotator cuff tear diagnosis who underwent arthroscopic rotator cuff repair between January 1, 2015, and December 31, 2021. Patients were stratified into the losartan group (LG) and nonlosartan group (NLG) on the basis of whether they had a coded prescription for losartan within 1 year before surgery or 3 months after surgery. The 2 cohorts were propensity scored and matched to reduce confounding biases. Specifically, cohorts were matched on the basis of age, gender, obesity, nicotine use, hyperlipidemia, diabetes, hypertensive diseases, ischemic heart disease, heart failure and valvular disease, and peripheral arterial disease. The incidence of additional shoulder surgeries associated with stiffness and rotator cuff healing was analyzed and compared at 1-year and 2-year time points.

Results: After propensity score matching, both the LG and NLG contained 3,970 patients. There was no difference in the rate of lysis of adhesions or manipulation under anesthesia at 1-or 2-year postoperatively between patients in the LG and LG. Patients in the LG were less likely undergo arthroscopic debridement (odds ratio 0.71; confidence interval 0.56-0.91; P = .006) and rotator cuff repair (odds ratio 0.71; confidence interval 0.58-0.87; P = .001) 1-year postoperatively than patients in the NLG group. At 1-year postoperatively, there was no difference in the rate of arthroplasty, arthroscopic synovectomy, and diagnostic arthroscopy between groups. At 2-year postoperatively, there was no difference in the rate of rotator cuff repair, arthroplasty, arthroscopic debridement, synovectomy, and diagnostic arthroscopy between groups.

Conclusions: Patients undergoing arthroscopic rotator cuff repair with or without a perioperative prescription for losartan had no significant difference in the rate of lysis of adhesions or manipulation under anesthesia at 1- or 2-year postoperatively, indicating that the antifibrotic properties of losartan may not have a clinically significant impact on shoulder stiffness after arthroscopic rotator cuff repair. However, patients with a prescription for losartan were less likely to undergo additional arthroscopic debridement and rotator cuff repair 1-year postoperatively than a matched cohort of patients without a prescription for losartan.

Level of evidence: Level III, case control study.