History of GLP-1 receptor agonists confer no improvement for Achilles tendon repairs: A national, propensity-matched comparison.

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to influence musculoskeletal repair pathways, but their clinical impact on tendon healing following Achilles tendon repair (ATR) remains unclear. Although emerging evidence suggests GLP-1RAs may modulate inflammation, preserve muscle, and promote tenogenic differentiation, no large-scale study has evaluated their effect on post-ATR outcomes. This retrospective, cohort study analyzed a multi-institutional research network of de-identified electronic health records, identifying patients who underwent ATR between 2015 and 2024 and stratifying them based on GLP-1RA use within one year prior to surgery. Primary outcomes included Achilles re-rupture, strain or re-injury, wound dehiscence, and surgical site infection at 90 days and 1 year postoperatively, with secondary outcomes including deep vein thrombosis, pulmonary embolism, tibial or sural neuropathy, and opioid use. One-to-one propensity score matching was performed for age, sex, race, and five comorbidities. Among the two matched cohorts of 853 patients each, no statistically significant differences were observed in 1-year re-rupture (OR 1.41 [0.70-2.81]) or surgical site infection (OR 0.71 [0.43-1.19]) (p > 0.01 for all comparisons), with all other outcomes similarly distributed. Absolute complication rates among GLP-1RA users aligned with established benchmarks, including a 1-year re-rupture rate of 1.5% and surgical site infection rate of 1.7%, with all outcome differences versus non-users remaining within a 5% margin. Despite their theorized regenerative benefits, GLP-1RAs were not associated with improved tendon healing or lower re-rupture rates following ATR, suggesting their use does not necessitate changes to perioperative management or risk stratification practices.