TESTOSTERONE THERAPY IS ASSOCIATED WITH INCREASED RATES OF ROTATOR CUFF TEARS, REPAIRS, AND REVISION REPAIRS: A NATIONAL DATABASE ANALYSIS

The prescription of testosterone to treat hypogonadism has increased significantly in the past decades. While supraphysiologic doses of anabolic steroids have been identified as a risk factor for tendon rupture, musculoskeletal complications in patients prescribed testosterone in the clinical setting has been sparsely studied. The purpose of the current study was to evaluate rates of rotator cuff tears (RCTs), repairs (RCR), and revision RCR in patients who were prescribed testosterone replacemet therapy (TRT) and compare these patients to a control group of patients not receiving TRT. The PearlDiver Database, a national insurance database, was queried for patients who were prescribed testosterone for at least 90 days between 2011 and 2018 to evaluate the incidence of RCTs in this population. A second analysis evaluated patients who sustained RCTs using International Classification of Diseases, 9th/10th codes to evaluate these patients for rates of RCR and Revision RCR. Chi-square analysis and multivariate regression analysis were used to compare rates of RCTs, RCR and subsequent or revision RCR between the testosterone and control groups, with a p-value of 0.05 representing statistical significance. 673,862 patients with RCT were included for analysis, and 9,168 of these patients were prescribed testosterone for at least 90 days prior to their RCT. The TRT group had a 3.6 times greater risk of sustaining an RCT (1.14% vs. 0.19%; adjusted Odds Ratio (OR) 3.57, 95% Confidence Interval (CI) 3.57–3.96). There was a 1.6 times greater rate of RCR in the TRT cohort (TRT, 46.4% RCR rate, control, 34.0% RCR rate; adjusted OR 1.60, 95% CI 1.54–1.67). The TRT cohort had a 26.7 times greater risk of undergoing a subsequent RCR, irrespective of laterality, within 1 year of undergoing a primary RCR when compared to the control group (TRT, 47.1%, control, 4.0%; adjusted OR 26.4, 95% CI 25.0–27.9, p < 0.001). There is increased risk of RCTs, RCRs, and subsequent RCRs in patients prescribed testosterone. This finding may represent a musculoskeletal consequence of TRT and is important for patients and clinicians to understand. Further research into the science of tendon injury in the setting of exogenous anabolic steroids remains of interest.