JSES International - 2026-05-01 - Journal Article
Osteoporosis is a risk factor for complications and reoperations at 1 and 3 years after arthroscopic rotator cuff repair.
Brown C, Johnson AH, Brennan JC, Peterman MA, Redziniak DE, Turcotte JJ
Topics
Key Takeaway
Osteoporosis increases risk of frozen shoulder (4.8% vs. 4.0%), proximal humerus fracture (1.0% vs. 0.7%), and TSA conversion (2.2% vs. 1.9%) at 3 years after arthroscopic rotator cuff repair.
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Summary
This study used the PearlDiver Mariner 170 database to compare complications after arthroscopic RCR in patients with vs. without a prior-year osteoporosis diagnosis, matched 1:1 on age, sex, and comorbidities. At both 1 and 3 years, the osteoporosis cohort had significantly higher rates of frozen shoulder, proximal humerus fracture, and TSA conversion, with all differences reaching statistical significance (P ≤ .038). Rates of repeat RCR, SSI, and MUA/lysis of adhesions did not differ significantly between groups.
Key Limitation
The PearlDiver dataset lacks imaging data, DEXA scores, tear size, repair technique, and tissue quality, making it impossible to determine whether osteoporosis independently drives outcomes or serves as a proxy for unmeasured disease severity.
Original Abstract
BACKGROUND
Osteoporosis is associated with compromised bone quality and healing potential. Arthroscopic rotator cuff repair (RCR) restores shoulder function and reduces pain in patients with rotator cuff pathology. The influence of osteoporosis on complications and long-term outcomes following RCR remains underexplored. This study aims to evaluate the relationship between osteoporosis and outcomes after arthroscopic RCR.
METHODS
The PearlDiver Mariner 170 dataset was retrospectively analyzed. Patients were grouped by whether they had a diagnosis of osteoporosis within the year prior to RCR. The 2 groups were propensity score matched 1:1 on age, gender, and comorbidities. Outcomes were assessed at 1 year and 3 years post-operatively. The outcomes of interest included repeat RCR, Surgical Site Infection, frozen shoulder (FS), proximal humerus fracture, total shoulder arthroplasty (TSA), and lysis of adhesions/manipulation under anesthesia.
RESULTS
After propensity score matching, there were no differences in demographics and comorbidities between groups. At 1 year post-operatively, the osteoporosis group had increased rates of FS (3.7% vs. 3.1%; P = .004), proximal humerus fracture (0.6% vs. 0.4%; P = .002), and TSA (1.2% vs. 0.9%; P = .012). This trend persisted at 3 years post-operatively, with the osteoporosis group continuing to have increased rates of FS (4.8% vs. 4.0%; P < .001), proximal humerus fracture (1.0% vs. 0.7%; P = .001), and TSA (2.2% vs. 1.9%; P = .038).
CONCLUSION
Patients with osteoporosis are at increased risk of FS, proximal humerus fractures, and TSA at 1 and 3 years after arthroscopic RCR. Overall rates of complication were low and osteoporosis should not be considered a contraindication to arthroscopic RCR.