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.