Effect of Combined Tendon Remnant Preservation and Bone Marrow Stimulation on Rotator Cuff Healing: A Propensity Score-Matched Study.

Abstract

Arthroscopic rotator cuff repair provides satisfactory functional results. However, imaging studies show a high healing failure rate. Recent studies on animal models evaluated the effect of preserving the tendon remnant of the rotator cuff on tendon healing, showing a positive impact by combining tendon remnant preservation and small bone vents on the greater tuberosity. The study aimed to evaluate the efficacy of a combined biologic augmentation technique consisting of tendon remnant preservation on the rotator cuff footprint and bone marrow stimulation of the greater tuberosity. Patients who underwent arthroscopic rotator cuff repair associated with small-diameter bone marrow stimulation holes, 1 mm in diameter (nanofractures) and tendon footprint preservation were included. Standard arthroscopic rotator cuff repairs were used as controls. The primary outcome was subjective functional assessment with the American Shoulder and Elbow Surgeons (ASES) Score. Secondary patient-reported outcomes were the short version of the Disability of the Arm, Shoulder and Hand (Quick-DASH) scale and the Western Ontario Rotator Cuff (WORC) Index, and structural integrity of repaired tendons by magnetic resonance imaging (MRI) performed six months after surgery. Significance tests were run to assess differences between groups for baseline characteristics and at follow-up. Statistical Significance was set at p < 0.05. The study included 52 patients (26 in each group). The mean age of patients was 64.8±6.9 years. Mean follow-up was 42.3±6.6 months. No significant differences between groups for baseline characteristics were found. Comparison between pre- and postoperative functional scores showed significant improvement at follow-up in both groups (p<0.001). No significant differences between groups were observed for primary and secondary clinical outcomes. Structural integrity was assessed in all the patients included. Significant difference between groups was observed in favor of the index group. Tendon healed in 14 (53.8%) and in 21 (80.8%) in the control and index group, respectively (p=0.039). Preservation of rotator cuff tendon remnant combined with small bone vents of the greater tuberosity during arthroscopic rotator cuff repair provided significant improvements in tendon healing rate compared to arthroscopic rotator cuff repair with soft tissue debridement and cortical abrasion of the greater tuberosity. Level III; Retrospective Cohort Comparison; Treatment Study.