Does estradiol supplementation improve rotator cuff repair outcomes in postmenopausal women?

Although rotator cuff tears are one the most common musculoskeletal sources of disability, healing after rotator cuff repair (RCR) fails in >25% of cases. Existing data suggest that estradiol deficiency may be associated with worse postoperative outcomes following RCR. Thus, the purpose of this study was to determine whether estradiol supplementation among postmenopausal women is associated with better outcomes after RCR and we hypothesized that such an association would exist.

A retrospective review of all patients who underwent RCR by the lead author was done to identify those who were female and ≥50 years old, thus presumed to be postmenopausal. For all patients, all medications were recorded the day of surgery by the anesthesiologist in the preanesthesia note. These notes were reviewed to determine which patients were taking hormone replacement therapy (ie. "HRT") and those who were not (i.e. "non-HRT) at the time of surgery. All patients were contacted at 2 years postoperatively. Subjective Shoulder Value (SSV), visual analog scale (VAS) for pain, and American Shoulder and Elbow Surgeons (ASES) score were collected, in addition to satisfaction and need for further reoperation.

Overall, 254 women underwent RCR, of whom 2-year outcomes were obtained in 184 (74%) of which 42 (23%) were on estradiol supplementation at the time of surgery. There were no differences between groups in preoperative SSV (43 ± 21 non-HRT vs. 38 ± 22 HRT, P = .209), VAS (5.6 ± 2.3 vs. 5.7 ± 2.3, P = .770), or ASES scores (46 ± 20 vs. 44 ± 19, P = .738). However, HRT postmenopausal patients had significantly better VAS (1.2 ± 2.1 vs. 0.3 ± 0.8, P < .001) and SSV scores (87 ± 16 vs. 95 ± 10, P = .003) at 2-years postoperatively when compared to non-HRT postmenopausal patients. There were no significant differences in satisfaction (96.3% vs. 90.3%, P = .605), ASES scores (87 ± 17 vs. 94 ± 11, P = .146), or reoperation rates (7.9% vs. 14.8%, P = .297).

Estradiol supplementation was associated with better outcomes in postmenopausal women undergoing RCR; however, these differences in VAS and SSV did not meet the minimal clinically important threshold. Future prospective randomized studies could be considered before prescribing estradiol to postmenopausal patients in the setting of RCR.