Abstract
Background The present study used a systematic review to analyse the risk of perioperative injections
during arthroscopic reconstruction of the rotator cuff of the shoulder. The questions
of interest were whether perioperative local injection increases the infection risk
and whether the number of postoperative revisions is increased.
Material and Methods A systematic review of the U. S. National Library of Medicine/National Institutes
of Health (PubMed) database and the Cochrane Library was performed using the PRISMA
checklist. The keywords used were “shoulder” and “arthroscopy” and “injection” and
“risk”. In the course of the study, work that was not also primarily concerned with
the reconstruction of the rotator cuff was excluded. English original articles and
case series were included that contained at least some arthroscopic reconstructions
of the rotator cuff. The risk of bias was determined using the Newcastle-Ottawa Scale.
The content of the articles relevant to the research questions was analysed.
Results 48 hits were primarily generated. 9 articles corresponded to the inclusion criteria
and were analysed. In the 6 studies with details on the injected substances, cortisone
was used in 98 – 100% of the cases. The reported infection and revision rates based
on insurance data were higher with injection than without. The risk of bias in the
studies analysed here was rather low based on the Newcastle-Ottawa Score. The risk
of infection after a cortisone injection before, during or after surgery was increased.
Injection was associated with infection in up to 8% of cases with injections within
two weeks of surgery. The risk of infection was increased by up to 11 times with injections
within 4 weeks after the operation. Likewise, the risk of revision surgery after injection
was increased, with the time intervals between injection and surgery sometimes differing
between studies.
Discussion Local infections and to a lesser extent revision surgery are associated with perioperative
injections (with cortisone) within 3 months preoperatively and 4 weeks postoperatively.
However, there were only database studies of insurance data with several studies from
a few centres. Thus, no causal relationships could be proven. Currently, however,
the following can be recommended using a cautious approach: The interval between injection
with cortisone before surgery should be at least 2 weeks, better 3 months. No cortisone
injections should be applied intraoperatively. Postoperatively, cortisone should not
be injected for at least 4 weeks. If, in exceptional cases, deviations from these
time limits are required, patients should be informed about an increased risk of complications.
Key words
shoulder - rotator cuff reconstruction - injection - risk - infection
