Despite recent advances in arthroscopic rotator cuff repair, re-tear rates remain high. New methods to improve healing rates following rotator cuff repair must be sought. Our primary objective was to determine if adjunctive bone marrow stimulation with channelling five to seven days prior to arthroscopic cuff repair would lead to higher Western Ontario Rotator Cuff (WORC) scores at 24 months postoperatively compared with no channelling. A prospective, randomized controlled trial was conducted in patients undergoing arthroscopic rotator cuff repair. Patients were randomized to receive either a percutaneous bone channelling of the rotator cuff footprint or a sham procedure under ultrasound guidance five to seven days prior to index surgery. Outcome measures included the WORC, American Shoulder and Elbow Surgeons (ASES), and Constant scores, strength, ultrasound-determined healing rates, and adverse events.Aims
Methods
Tears of the rotator cuff tendons are a very common entity. Despite recent advances in arthroscopic rotator cuff repair, the re-tear rate remains high. Thus, new methods to improve healing rates following rotator cuff repair must be sought. The purpose of this prospective randomized double-blind controlled study is to compare the functional outcomes and healing rates of an adjuvant pre-operative bone microfracture technique prior to arthroscopic cuff repair. Patients undergoing arthroscopic rotator cuff repair were randomized to receive either a percutaneous bone microfracture of the supraspinatus footprint or a “soft tissue needling” technique, in which the pin was passed through the peripheral edges of the rotator cuff, five-seven days prior to index surgery, under ultrasound guidance. Follow-ups were completed at 3, 6, 12 and 24 months post-operatively. Healing status was determined by ultrasound at 6 and 24 months. The primary objective was to compare the WORC score at 24 months. Secondary objectives included the healing status via ultrasound, the Constant, and the ASES scores. A sample size calculation determined that 90 patients provided 80% power to detect a statistical difference between groups. Baseline demographic data did not differ between groups. No statistical differences were detected in the WORC outcome at any time points (p=0.47, baseline, p=0.60, 3 months, p=0.79, 6 months, p=0.50, 12 months, p=0.54, 24 months). Healing rates did not differ between groups (P=0.34) and no differences were observed in the ASES or Constant Scores at all time-points. Statistically significant improvements occurred in both groups from baseline to all time points in all clinical outcome scores (p < 0 .0001). No statistically significant differences in primary or secondary outcomes were identified between pre-operative bone microfracture and soft tissue needling techniques prior to arthroscopic rotator cuff repair. This study does not support pre-operative microfracture as a adjuvant technique prior to arthroscopic cuff repair.
