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Published on: January 13, 2026
Intraoperative Zoledronic Acid for Arthroscopic Rotator Cuff Repair: Short-Term Results From a Prospective,
Jakob E Schanda1,2,3,4, Roman Ullrich5, Sandra Boesmueller1
1Department of Orthopedics and Trauma Surgery, AUVA Trauma Center Vienna-Meidling, Vienna, Austria.
Background:
Despite technical innovations and surgical improvements, retear rates after arthroscopic rotator cuff (RC) repair remain high. Preclinical studies demonstrated improved outcomes using bisphosphonates after RC repair.
Purpose/Hypothesis:
The purpose of this monocentric, prospective, randomized, placebo-controlled, triple-blinded phase II trial was to investigate retears in patients without osteoporosis undergoing arthroscopic RC repair with a systemic single-dose zoledronic acid. It was hypothesized that zoledronic acid would reduce retears after RC repair.
Study Design:
Randomized controlled trial; Level of evidence, 1.
Methods:
A total of 80 patients were intraoperatively randomized to the zoledronic acid group (n = 40) or the control group (n = 40). All patients underwent magnetic resonance imaging 6 months after surgery. Range of motion, abduction strength, Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and Visual Analog Scale (VAS) for pain were assessed preoperatively as well as 3 and 6 months after arthroscopic RC repair.
Results:
At 6 months, retears were significantly lower (P = .001) in the zoledronic acid group (n = 6; 15%) compared with the control group (n = 14; 35%). The risk of a RC retear with an additional zoledronic acid treatment (RR, 0.43 [95% CI, 0.16; 0.98]) was significantly lower compared with that of the control group (OR, 0.328; 95% CI, 0.111-0.969; P = .044). Postoperative fatty muscle infiltration of the supraspinatus was significantly lower in the zoledronic acid group compared with the control group (P < .001). Clinical and functional outcomes significantly improved in the 2 study groups 3 and 6 months postoperatively, with better outcomes for abduction (P = .002), forward flexion (P = .002), external rotation (P = .001), CMS (P < .001), ASES score (P < .001), SSV (P < .001), and VAS for pain (P < .001) in the zoledronic acid group at the final follow-up.
Conclusion:
An intraoperative systemic single-dose zoledronic acid reduced retears after arthroscopic RC repair. Zoledronic acid is a safe, easy-to-apply, and cost-effective augmentation technique for patients undergoing arthroscopic RC repair.
Registration:
NCT05677152 (ClinicalTrials.gov identifier).
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