The Role of Vitamin D in Postoperative Tendon Healing: A Scoping Review

Tendon injuries pose significant clinical challenges because of poor vascularity and complex biomechanics, often leading to suboptimal healing. While surgical advancements and rehabilitation protocols have improved outcomes, delayed healing and high retear rates remain prevalent. Vitamin D, a key regulator of musculoskeletal health, may influence tendon healing through extracellular matrix remodeling, inflammation modulation, and cell proliferation. However, its effect on tendon repair remains unclear, with most studies focusing on rotator cuff tendons. This scoping review synthesizes current evidence on vitamin D's role in tendon healing and identifies gaps in the literature.

The purpose of this scoping review is to evaluate the available literature on vitamin D's role in tendon healing and its influence on postoperative recovery. It was hypothesized that vitamin D deficiency is associated with poorer healing outcomes and increased failure rates.

Scoping review; Level of evidence, 4.

A systematic search of Embase, OVID Medline, and Emcare databases was conducted through November 2024. Eligible studies included observational studies and randomized controlled trials assessing vitamin D status in adults undergoing tendon repair. Two independent reviewers screened and extracted data, resolving discrepancies with a third reviewer. Study quality was evaluated using the methodological index for non-randomized studies score. Given the heterogeneity of studies, results were synthesized narratively, focusing on evidence gaps across different tendons.

A total of 10 studies met inclusion criteria, with the majority focusing on rotator cuff repairs (n = 8). Vitamin D deficiency was consistently associated with poorer postoperative outcomes, including delayed healing, higher retear rates, and decreased functional recovery. Mechanistic studies suggested that vitamin D enhances healing through extracellular matrix remodeling and inflammation modulation. However, the overall quality of evidence was low, with most studies being retrospective. Notably, half of the studies relied on the same large administrative database, leading to potential patient overlap and limiting independent conclusions. Research on vitamin D's role in healing other tendons, such as the Achilles, patellar, and flexor tendons, was lacking.

Although evidence suggests vitamin D may support tendon healing, particularly in rotator cuff repair, studies remain low quality and limited to a single tendon group. Future prospective cohort studies and randomized controlled trials are needed to establish causality, assess its effects across various tendons, and determine optimal supplementation strategies.