Hypogonadism is associated with worse outcomes in arthroscopic rotator cuff repair

The purpose of this pilot study was to determine the association between systemic circulating factor abnormalities known to associate with fracture nonunion and outcomes after rotator cuff repair (RCR).

This was a prospective study of patients undergoing RCR. Preoperatively and at six months postoperatively, we collected patient-reported outcomes, including visual analog scale for pain scores, simple shoulder test scores, American Shoulder and Elbow Surgeons scores, and a magnetic resonance imaging scan. Preoperatively, we also collected a battery of serum hormone, vitamin, and metabolic tests, including testosterone, estradiol, thyroid-stimulating hormone, luteinizing hormone, vitamin D, calcium, alkaline phosphatase, hemoglobin A1C, and a lipid panel. In men, we collected the Androgen Deficiency in the Aging Male score and, in women, we collected the menopause rating scale, and these scores were defined as normal or abnormal based upon previously published norms.

Of the 50 included patients, 46/50 (92%) had clinical and 41/50 (82%) had magnetic resonance imaging follow-up at six months. Forty-three percent (19/44) of included patients were hypogonadal, 32% (12/38) had hypovitaminosis D, 66% (29/44) had dyslipidemia, and 37% (17/46) were diabetic or prediabetic. One hundred percent were euthyroid, normocalcemic, and had normal alkaline phosphatase. Hypogonadism was associated with significantly worse visual analog scale for pain (2.5 ± 2.2 vs. 1.0 ± 1.1, P = .014), simple shoulder test (10 ± 30 vs. 11 ± 20, P = .037), and American Shoulder and Elbow Surgeons (74 ± 19 vs. 88 ± 11, P = .006) scores postoperatively. While not significant (P = .102), hypogonadism was associated with lower healing rates (36% vs. 63%). Hypovitaminosis D, diabetes, and dyslipidemia did not associate with clinical outcomes. Dyslipidemia was associated with significantly higher healing rates (71% vs. 31%, P = .036).

While almost all patients undergoing RCR suffered from systemic biologic deficiencies, only hypogonadism was associated with significant differences in patient-reported outcomes. Given that this factor is modifiable, this result supports larger studies with longer follow-up and exploration of hormone replacement therapy.