Original Article
Effect of Recombinant Human Parathyroid Hormone on Rotator Cuff Healing After Arthroscopic Repair

https://doi.org/10.1016/j.arthro.2018.11.038Get rights and content

Purpose

To assess the effect of teriparatide, a recombinant human parathyroid hormone, on rotator cuff healing after arthroscopic repair compared with patients who were not treated with teriparatide.

Methods

This was a prospective propensity-matched study. Thirty-one patients who underwent arthroscopic rotator cuff repair for tears >2 cm in size between January 2015 and June 2016 were recruited (group I). Daily subcutaneous injections of teriparatide 20 μg were administered for 3 months following surgery. In the same period, propensity score matching (1-to-4) was performed to generate an untreated control group undergoing rotator cuff repair alone (group II) with the same tear size. Magnetic resonance imaging evaluation of tendon healing was performed at least 1 year postoperatively, as well as the range of shoulder motion, American Shoulder and Elbow Surgeons score, Constant score, and simple shoulder test.

Results

There was no significant difference of the retraction size, the anterior to posterior dimension of torn rotator cuff, or the preoperative bone mineral density in groups I and II (P = .78, .87, and .96, respectively). The rate of retear was significantly lower in group I than in group II (16% vs 33.9%; P = .04). Range of motion and functional scores were not significantly different between the 2 groups (P > .05).

Conclusions

Teriparatide, a recombinant human parathyroid hormone, can be a systemic treatment option that significantly enhances the tendon-to-bone healing after arthroscopic rotator cuff repair for patients with rotator cuff tears >2 cm.

Level of Evidence

Level III, case-control study.

Section snippets

Methods

This study was a prospective comparative case-control study with propensity matching of the control group. Data collection and all protocols were approved by the Seoul National University Bundang Hospital Institutional Review Board of the senior author's (J.H.O.) institution (IRB No. B-1802/450-111).

According to the power analysis, the sample size required 31 patients in the treatment group and 124 patients in the control group. Assuming a 20% dropout rate, 40 patients were needed in the group

Results

Figure 1 shows the total number of patients undergoing rotator cuff surgery in the study period and the number analyzed after exclusions. Patients’ demographic characteristics are shown in Table 1. The mean BMD was –1.6 ± 1.1 in group I and –1.6 ± 1.3 in group II (P = .959). Ten patients (32.3%) in group I and 40 patients (32.3%) in group II had osteoporosis (P = .975). None of the patients who had osteoporosis in group I had a treatment history of osteoporosis. Among the 40 patients who had

Discussion

The most important finding from the current data was that teriparatide had an effect on enhancing tendon-to-bone healing; in patients who had been treated with teriparatide, the rate of retear was significantly reduced compared with that of the control group (16.1% vs 33.9%; P = .037).

Several studies demonstrated the effect of teriparatide not only on treating osteoporosis but also on enhancing tendon-to-bone healing.16, 27, 28 Hettrich et al.16 reported that an rhPTH resulted in more

Conclusions

Teriparatide, an rhPTH, can be a systemic treatment option that significantly enhances the tendon-to-bone healing after arthroscopic rotator cuff repair for patients with rotator cuff tears >2 cm.

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    See commentary on page 1072

    The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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