The Greenhouse technique provides lower retear rate and similar outcomes in rotator cuff repair: a prospective randomized controlled trail.

Abstract

It is still an important issue to reduce the rate of retear after arthroscopic rotator cuff repair (ARCR). A new ARCR technique named "Greenhouse technique" (GH) combined with microfracture was proposed to enhance the rotator cuff healing. The purpose of this study was to compare the clinical outcomes and retear rate of GH technique with traditional single-row repair (SR) in full-thickness rotator cuff tear (FT-RCT) patients in the short-term follow-up. We hypothesized that the GH technique would provide lower retear rate and similar clinical outcomes in ARCR. From December 2020 to March 2021, a total of 114 FT-RCT patients who received ARCR were randomized into 2 groups, GH group (56 patients) and SR group (58 patients). Functional outcomes including American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Constant-Murley, UCLA, Simple Shoulder Test, visual analog scale for pain, and range of motion (ROM), including forward elevation, external rotation, and internal rotation were evaluated preoperatively, 24 months postoperatively, and compared between 2 groups. Tendon integrity was evaluated by MRI preoperatively and 2 years postoperatively. Bone tunnel healing was evaluated by CT at 3 and 6 months postoperatively. Sugaya classification was used to evaluate tendon retear and compared between 2 groups. The percentage of patients reaching the Minimal Clinically Important Difference (MCID), patient acceptable symptom state (PASS), substantial clinical benefit (SCB) based on the ASES score were also compared between 2 groups. All functional outcomes and ROM improved significantly compared with the preoperative index in both groups (all P < .001) at the 24-month follow-up. However, there were no significant differences between the 2 groups at final follow-up. Overall, 116 patients (85.7%) exceeded the MCID, 114 patients (73.3%) achieved the PASS, and 98 patients (85.0%) achieved SCB without significant differences between the 2 groups. The overall retear rate after ARCR in the GH group was 5.4% and 19.0% in the SR group separately, and the GH group had a significantly lower retear rate than that in the SR group (P = .027). In 49 patients (90.7%), the bone tunnel disappeared in 3 months postoperatively. Both GH and SR groups achieved significant improvement after ARCR. Compared with the SR group, the GH technique group provided lower retear rates and similar clinical outcomes in the short-term follow-up.