Effectiveness of Teriparatide (rhPTH) in Enhancing Functional Recovery After Arthroscopic Rotator Cuff Repair: A Triple-Blind Randomized Clinical Trial.

Abstract

Background: Rotator cuff tears are common musculoskeletal injuries frequently requiring surgical intervention, yet retears occur at a notable rate. Teriparatide (recombinant human parathyroid hormone, rhPTH) has shown promise in animal studies for enhancing bone and tendon healing. However, limited human data exist on its clinical benefits when used adjunctively in arthroscopic rotator cuff repairs.

Purpose: To investigate whether the systemic administration of teriparatide improves functional outcomes following arthroscopic rotator cuff repair in a triple-blind, randomized controlled trial (RCT).

Methods: Fifty adult patients (aged 50-80 years) with degenerative rotator cuff tears were randomized (1:1) to receive daily subcutaneous injections of either teriparatide (20 μg) or placebo for 3 months after arthroscopic repair. Blinded evaluators assessed participants at baseline, 6 months, and 1 year. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included range of motion (ROM), Visual Analog Scale (VAS) for pain, nighttime pain, painkiller use, and magnetic resonance imaging (MRI) assessment of tendon integrity (Sugaya classification).

Results: Final analyses included 43 participants (rhPTH group = 23, control group = 20). Both the rhPTH and control groups demonstrated significant within-group improvements in ASES scores, ROM, and pain scores from baseline to 1 year (p < 0.0001). However, no significant between-group differences were observed at the 6-month or 1-year follow-up for the ASES score (p = 0.87), ROM in all planes, or VAS pain scores. MRI evaluations at 1 year showed comparable retear rates (8.7% vs. 10%, p = 0.94), indicating no significant advantage of teriparatide in promoting tendon integrity.

Conclusion: In this triple-blind RCT, teriparatide did not confer additional benefits over placebo in improving functional outcomes or reducing retear rates 1 year after arthroscopic rotator cuff repair. Larger RCTs that include a broader patient population are required to fully clarify the role of teriparatide in enhancing rotator cuff repair outcomes.

Level of evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.