Outcomes After Combined Remnant Preservation and Bone Marrow Stimulation for Acute Rotator Cuff Tears.

BACKGROUND

Both remnant preservation (RP) and bone marrow stimulation (BMS) enhance the healing potential of the repaired rotator cuff by improving the biological milieu of the tendon-bone interface.

PURPOSE

To evaluate the clinical and imaging outcomes of arthroscopic rotator cuff repair using a combined RP-BMS technique in patients with acute rotator cuff tears.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Between January 2016 and June 2019, a total of 56 patients were diagnosed with acute rotator cuff tears; 29 patients underwent conventional repair (group 1), and 27 patients underwent RP-BMS (group 2). At a minimum follow-up period of 2 years, the authors compared clinical outcomes with the University of California-Los Angeles; Constant; American Shoulder and Elbow Surgeons; and pain visual analog scale scores as well as shoulder range of motion. Tendon integrity and retear were assessed on magnetic resonance imaging according to the Sugaya classification (intact, grades 1-3; retear, grades 4-5). Between-group comparisons were conducted using the Student test or Mann-Whitney test for continuous variables and the Pearson chi-square test or Fisher exact test for categorical variables.

RESULTS

In both groups, patients had significant preoperative to postoperative improvement on all clinical outcome measures ( = .001 for all). Shoulder abduction in group 2 was significantly greater compared with group 1 at the postoperative 3-month (107.37° ± 8.32° vs 95.44° ± 8.78°; = .001), 6-month (155.25° ± 10.02° vs 144.72° ± 9.28°; = .001), and final (165.15° ± 9.17° vs 158.31° ± 8.01°; = .021) follow-ups. At the final follow-up, significantly more patients in group 2 had intact tendons (Sugaya grades 1-3) compared with group 1 ( = .015), and the tendon retear rate was lower in group 2 (1/27; 3.70%) than in group 1 (7/29; 24.14%) ( = .033).

CONCLUSION

Both surgical techniques led to satisfactory clinical outcomes, but shoulder abduction was greater after the RP-BMS technique compared with conventional repair. RP-BMS may be an alternative surgical technique to improve tendon integrity and retear rates after the repair of acute rotator cuff tears.