ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026
Metformin use and outcomes after arthroscopic full thickness rotator cuff repair: a real-world, propensity score-matched cohort study.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeEvaluate the impact of preoperative metformin use on surgical outcomes and reoperation rates following arthroscopic rotator cuff repair.
methodsUsing the TriNetX database, patients with full-thickness rotator cuff tears undergoing arthroscopic repair were identified and stratified by preoperative metformin use (within 6 months to 2 weeks before surgery). Cohorts were matched 1:1 via propensity scores for comorbidities. Outcomes including stiffness, bursitis, reoperation, total shoulder arthroplasty (TSA), manipulation under anesthesia (MUA), and adhesive capsulitis were assessed at 3 months, 6 months, 1 year, and 2 years.
resultsEach cohort included 3049 patients. At 90 days, metformin users had lower cuff revision rates [1.41% vs. 2.16%, risk ratio RR 0.65 (95% confidence interval CI 0.45,0.95), p = 0.026)]. Postoperative stiffness remained consistently higher in the metformin group at all timepoints, including 90 days [11.58% vs. 7.77%, risk ratio RR 1.49 (1.27,1.74)], 6 months [12.66% vs. 9.12%, RR 1.39 (1.2,1.61)], 1 year [13.48% vs. 10.07%, RR 1.34 (1.17, 1.54)], and 2 years [13.91% vs. 10.56%; RR 1.32 (1.15, 1.51); all p < 0.0001]. Bursitis was more frequent at 1 year [9.77% vs. 8.17%, RR 1.20 (1.02, 1.41), p = 0.028] and 2 years [11.68% vs. 10.04%, RR 1.16 (1.01,1.34), p = 0.040]. Rates of TSA, MUA, and adhesive capsulitis were similar at all time points.
conclusionPreoperative metformin is associated with increased postoperative stiffness but lower early cuff revision rates after RCR. These associations appear limited to the short term, while long-term outcomes suggest no increased risk of cuff revision surgery. Further studies are needed to explore underlying mechanisms. LEVEL OF EVIDENCE III: Retrospective study.
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