GLP-1RAs show no increased post-op complications for rotator cuff repair, but link to higher atraumatic tears and improved preclinical healing.
Background
Obesity and type 2 diabetes mellitus (T2DM) significantly impair rotator cuff tendon healing and worsen surgical outcomes. Current treatments often fall short in addressing these underlying metabolic factors that compromise tendon repair. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are widely used for managing obesity and T2DM, yet their specific impact on rotator cuff disease biology and patient outcomes following surgical repair remains largely unexplored, creating a critical knowledge gap for clinicians and patients.
Study Design
This study performed a scoping review following PRISMA-ScR guidelines to synthesize existing evidence on GLP-1RA and rotator cuff disease. Researchers systematically searched MEDLINE, Embase, PubMed, and the Cochrane Library from inception up to January 28, 2026. Eligible studies included human observational cohort studies and preclinical experimental studies. Data extraction was conducted independently by two reviewers, and findings were descriptively synthesized to identify associations and trends.
Results
The review included six studies: four human retrospective cohort studies and two controlled preclinical studies. The human studies comprised a substantial 1,481,529 patients, with 391,716 identified as GLP-1RA users. Preoperative GLP-1RA use was not associated with increased postoperative complications following rotator cuff repair. However, GLP-1RA use was associated with an increased incidence of atraumatic rotator cuff tears and subsequent repair. In contrast, preclinical models of acute rotator cuff injury and repair demonstrated that liraglutide improved biomechanical strength and organization of the repaired tendon-bone interface. Furthermore, liraglutide reduced fatty infiltration and attenuated cellular stress responses in these models, suggesting a potential beneficial influence on tissue healing at a mechanistic level.
Preoperative GLP-1RA use was not associated with increased postoperative complications following rotator cuff repair.
Key Findings
- Preoperative GLP-1RA use was not associated with increased postoperative complications following rotator cuff repair.
- GLP-1RA use was associated with increased incidence of atraumatic rotator cuff tears and subsequent repair.
- Preclinical models showed liraglutide improved biomechanical strength and organization of the repaired tendon-bone interface.
- Liraglutide reduced fatty infiltration and attenuated cellular stress responses in preclinical models.
Why It Matters
GLP-1RA users should be aware of a potential association with a higher incidence of atraumatic rotator cuff tears, despite no evidence of increased postoperative complications after repair. This suggests a complex relationship where GLP-1RA might influence tendon integrity over time, even as it appears safe perioperatively. The preclinical data hinting at improved healing with liraglutide offers a promising, albeit early, direction for future research into optimizing tendon repair in metabolic conditions. For now, no changes to existing GLP-1RA protocols are indicated, but clinicians should consider this association in patient counseling. High-quality prospective studies are crucial to clarify these effects and potentially inform future therapeutic strategies.
glp-1ra
liraglutide
rotator-cuff-disease
obesity
type-2-diabetes
tendon-healing