2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Arthroscopic Rotator Cuff Repair Utilizing Mechanical Bone Debridement Versus Coblation Technology: A Prospective Randomized Double-Blind Trial

Ylan Tran, MD, FRCSC, Calgary, Alberta CANADA
Tong Liu, MD, PhD, Changchun, jilin CHINA
Justin Eugene Matthew LeBlanc, MD, FRCSC, MSc, Calgary, Alberta CANADA
Ian K. Y. Lo, MD, FRCSC, Calgary, Alberta CANADA
Kristie Dawn More, MSc, Redwood Meadows, Alberta CANADA

University of Calgary, Calgary, AB, CANADA

FDA Status Not Applicable

Summary

This randomized control trial finds that coblation debridement for preparing the rotator cuff footprint results in similar re-tear rates to mechanical debridement, but with the added benefit of being faster and that preoperative Sugaya and Goutallier scores are the most significant predictors of post-operative re-tears.

Abstract

Background

One of the most common complications following arthroscopic rotator cuff repair is non-healing or retearing of the rotator cuff. Preparation of the bony footprint may be performed using shavers, burrs and curettes, and is a critical step to promote tendon-to-bone healing. However, this step can be imprecise and time-consuming. Radiofrequency devices or coblation devise can be utilized to improve the efficiency of this process, but the impact of coblation technology on tendon-to-bone healing and re-tears rate has yet to be documented.

Purpose

This study aimed to prospectively evaluate whether the use of coblation devices for footprint preparation is associated with a higher re-tear rate compared to mechanical debridement (i.e. shaver,burr). Additionally, the study explored factors influencing re-tear rates, including chronicity of tear, pre-operative tear size, fatty infiltration, and the presence of co-morbidities such as age, diabetes and nicotine usage.

Methodology

This double-blind, randomized trial included patients with full-thickness rotator cuff tears. Upon confirming a reparable tear intra-operatively, patients were randomly assigned to either coblation or mechanical debridement of the humeral footprint, following a standardized protocol. Patients underwent a standard post-operative rehabilitation program. Preoperative and 12-month follow-up MRIs were used to assess re-tear rates, classified by Sugaya grades 4 and 5. Post-operative re-tear rates were also correlated to preoperative fatty infiltration (Goutallier classification) and tendon retraction (Patte classification) and co-morbities.

Results

The trial included 68 shoulders (46 males [68%], 22 females [32%]), with 29 in the coblation group and 39 in the mechanical debridement group. The mean tear size was 18 +/- 4 mm in the sagittal plane, and the mean tendon retraction was 21.3 +/- 11.0 mm. During surgery, footprint preparation was significantly faster with coblation (120 ± 60 seconds) compared to mechanical debridement (180 ± 60 seconds) (p = 0.0005).
At the one-year follow-up, 24 patients (35%) had a re-tear on post-operative MRI: 7 out of 29 (24%) in the coblation group and 17 out of 39 (44%) in the mechanical debridement group. There was no significant difference in retear rate between groups (p=0.44). Post-operative Sugaya grades were strongly correlated with preoperative Patte grade (p = 0.027) and Goutallier grade (p = 0.010). Other risk factors, such as age, chronicity of tear, diabetes mellitus, and nicotine usage, were not significantly linked to re-tear rates (p = 0.98, p = 0.58, p = 0.49).

Conclusion

Coblation debridement yields re-tear rates comparable to mechanical debridement, while being a significantly faster technique, making it a viable method for preparing the humeral footprint in rotator cuff repair. Preoperative Sugaya and Goutallier scores were identified as the most significant predictors of post-operative re-tears.