Angiotensinogen II Receptor Blockers May Decrease Risk of Adhesive Capsulitis After Rotator Cuff Repair

Abstract

Purpose

To determine the effect of commonly prescribed antifibrotic medications on the odds of developing adhesive capsulitis (AC) following arthroscopic rotator cuff repair.

Methods

The Mariner data set of the PearlDiver database from 2010 to 2022 was used to identify patients aged 40 to 65 years who underwent rotator cuff repair (identified by Current Procedural Terminology codes) with an ipsilateral rotator cuff tear (identified by International Classification of Diseases, 10th Revision codes). Patients were required to have filled a prescription for only one of the following medications before and within 3 months of surgery: angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors, cyclooxygenase 2 inhibitors, and statins. Patients who developed ipsilateral AC within 6 months after surgery were identified using International Classification of Diseases codes. Additionally, all patients who underwent a manipulation under anesthesia (MUA) and/or arthroscopic lysis of adhesions (LOA) within 6 months of diagnosis of AC were identified using Current Procedural Terminology codes.

Results

A total of 183,563 patients met study inclusion criteria and were stratified based on the development of postoperative AC. The baseline characteristics (age, sex, smoking status, and diabetes and obesity prevalence) between the 2 groups were statistically different, except for the Charlson Comorbidity Index. In total, 4.62% (8,485/183,563) developed postoperative AC, and 8.5% (717/8,485) and 5.2% (438/8,485) of patients who developed AC underwent subsequent MUA and LOA, respectively. Patients on an ARB had an odds ratio of 0.87 (P = .04) for the development of AC. No other medication usage had a significant change in odds for the development of AC, nor did any medication have a change in odds of undergoing MUA or LOA.

Conclusions

Patients on an ARB had lower odds of being diagnosed with AC within 6 months of surgery. Once diagnosed with AC, there was no difference in odds of undergoing MUA or LOA among any of the medication groups.

Level of Evidence

Level III, retrospective cohort study.