Statin therapy is not associated with inferior postoperative outcomes after arthroscopic rotator cuff repair: a systematic review and meta-analysis

Despite historical concerns regarding muscle and tendon toxicity, preclinical studies suggest statins may exert anti-inflammatory and antifibrotic effects relevant to rotator cuff tendon-bone healing. Clinical studies of statin use after arthroscopic rotator cuff repair (ARCR) report mixed results with respect to tendon healing, revision surgery, and functional outcomes. This systematic review and meta-analysis evaluated postoperative healing and patient-reported outcomes between statin users and non-statin users following ARCR. PubMed, Scopus, the Cochrane Library, and Web of Science were systematically searched from database inception through November 30, 2025, yielding 810 records for screening, of which 6 high-quality and one moderate-quality study were included based on the Newcastle-Ottawa Scale. Studies compared postoperative outcomes between statin users and non-statin users following ARCR, with outcomes including structural healing or retear, revision surgery, and patient-reported outcome measures such as the American Shoulder and Elbow Surgeons score and visual analog scale pain score. One Level II and 6 Level III studies comprising 7,653 statin users and 6,830 non-statin controls were included. Retear was assessed using postoperative magnetic resonance imaging based on loss of tendon integrity. Meta-analysis demonstrated no significant difference in retear rates between statin and non-statin users (risk ratio = 1.14; 95% confidence interval [CI], 0.54-2.42; P = .73). Revision surgery risk was significantly lower among statin users (risk ratio = 0.83; 95% CI, 0.70-1.00; P = .04), though this analysis was heavily weighted by a large administrative database study. Improvements in American Shoulder and Elbow Surgeons scores (mean difference = -1.56; 95% CI, -5.39 to 2.28; P = .43) and visual analog scale pain scores (standardized mean difference = 0.22; 95% CI, -0.11 to 0.55; P = .19) were comparable between groups. Statin use was not associated with increased retear risk or worse functional outcomes after ARCR but was associated with lower revision surgery rates. Postoperative failure may be more closely associated with underlying hyperlipidemia status than statin exposure alone; however, future lipid-stratified studies are needed to clarify the relationship between dyslipidemia, statin therapy, and postoperative risk.