Vitamin D and rotator cuff healing
March 7th, 2012
In a study published in the October 2010 issue of The Journal of Bone and Joint Surgery, Ljiljana Bogunovic et al. present the results of a study in which they reviewed the vitamin-D levels of patients undergoing orthopaedic surgery. The authors reviewed the charts of 723 patients scheduled for orthopaedic surgeries between January 2007 and March 2008. They wanted to determine how prevalent vitamin-D deficiency is among patients undergoing a wide variety of orthopaedic procedures.
Among all the patients in this study, 43% were found to have levels of vitamin D there were felt to be insufficient (or less than the value felt to represent normal values – 32 ng/mL). 40% of those were felt to be vitamin D-deficient, meaning they had levels less than 20 ng/mL. When the results were broken down by age, the results were somewhat surprising. Patients between the ages of 51 and 70 were noted to be 35% less at risk for having low vitamin-D levels compared to patients between the ages of 18 and 50. African-Americans and Hispanic patients were more likely to have a low vitamin-D level compared to Caucasians and Asians. Obese patients were twice as likely to have low vitamin-D levels compared to non-obese patients.
An internal medicine physician had cleared all patients in the study for surgery. Since patients with medical conditions that prevented them from having surgery were not included, the results seen here represented seemingly healthy patients. This is concerning for those of us who perform rotator cuff surgery quite commonly in the 51-70 age range. High failure rates of spinal fusion surgery have been reported in this age group due to failure at the bone-implant junction. One area of concern for us who do arthroscopic repairs with anchors is the quality of bone. Failure at the bone-implant junction may be one reason for recurrent tears!
data supports that Vitamin D deficiency may also have an adverse effect on soft tissue quality! So failure may occur here as well due to pull out of sutures! This is a concerning problem for rotator cuff surgery in the 51-70 year old age group. Thus far there are NO studies that have accurately addressed this potential, but it does make me take pause...
. It may be time to add a DEXA scan and Vitamin D level analysis in this group before we perform surgery!