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Perioperative Intravenous Dexamethasone Improves Pain and Functional Outcomes After Arthroscopic Rotator Cuff Repair
Trevor D Wolterink1, Germain Craddock1, Joshua P Castle1
1Department of Orthopaedic Surgery Henry Ford Health Detroit Michigan U.S.A.
Purpose:
To evaluate the effect of perioperative dexamethasone on patient-reported pain, functional outcomes, and minimal clinically important difference (MCID) achievement following arthroscopic rotator cuff repair.
Methods:
Patients who underwent rotator cuff repair between 2013 and 2023 were identified and divided into groups. Those who received peri operative dexamethasone were compared with controls. Outcomes included visual analog scale (VAS) pain, patient-reported outcomes measurement information system (PROMIS) upper extremity, PROMIS pain interference, and MCID. Multivariate logistic and linear regression models adjusted for age, sex, body mass index, diabetes, race/ethnicity, smoking, and preoperative opioid use. Subgroup analyses were performed by tear size.
Results:
A total of 309 patients was included (187 dexamethasone and 122 control). Dexamethasone administration was associated with improved functional recovery and sustained pain reduction. PROMIS upper extremity and PROMIS pain interference scores favored Dexamethasone at 6 weeks, 3 months, and 6 months (all P < .01). VAS pain was significantly lower at 12 months (1.9 ± 2.9 vs 3.1 ± 3.5, P = .003) and 24 months (1.0 ± 2.5 vs 1.8 ± 3.1, P = .035). Only 37% of patients completed a 2-year follow-up, limiting the strength of these long-term comparisons. In small/medium tears, MCID achievement for VAS was greater at 6 weeks (31% vs 21%, P = .041) and 3 months (34% vs 21%, P = .012). Logistic regression confirmed dexamethasone as an independent predictor of early MCID (OR 1.67, 95% CI 1.02-2.73, P = .041). Large/massive tears showed transient VAS improvement without MCID benefit. Opioid consumption did not differ between groups (all P > .12). Dexamethasone reduced ondansetron use in large/massive tears at 0-4 hour (β = -0.34, P = .04) and in small/medium tears at 4-8 hour (β = -0.19, P = .04), with no differences for other antiemetics. Complication rates were similar (11.2% vs 4.9%, P = .055).
Conclusions:
Perioperative intravenous dexamethasone is a safe adjunct to arthroscopic rotator cuff repair, supporting early antiemetic benefits, durable pain relief, and selective improvements in patient-reported outcomes. Benefits appear most pronounced in small/medium tears at early follow-up and large/massive tears at later stages, suggesting tear size-specific response.
Level Of Evidence:
Level III, retrospective comparative study.
