Rotator cuff repair has excellent clinical outcomes but continues to be a challenge when it comes to large and massive tears as well as revision procedures. Reported symptomatic retear rates are still too high to be acceptable. The purpose of the present study was to evaluate the efficacy of a combination of augmentation techniques consisting of nanofractures of the greater tuberosity, porcine dermal patch and subsequent platelet rich plasma (PRP) subacromial injections for the arthroscopic treatment of symptomatic rotator cuff retears.
The study was designed as a prospective comparative cohort study in a consecutive series. Forty patients with a symptomatic rotator cuff retear underwent an arthroscopic revision. Pattern and reparability of cuff retear were preoperatively documented on a magnetic resonance imaging (MRI) and staged according to the Sugaya’s classification. Only patients affected by stage IV-V were considered eligible. Tear reparability was confirmed during surgery. Patients were treated according two different techniques. In group 1 (20 patients) a standard revision and nanofractures of the greater tuberosity were performed; in group 2 (20 patients), nanofractures of the greater tuberosity and a porcine dermal matrix were used to enhance tendon repair, followed by postoperative PRP injections. Minimum follow-up was 12 months. Primary outcome was the Constant-Murley score (CMS) normalized for age and gender. Subjective outcome was assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) score in its short version (Quick-DASH). Tendon integrity was assessed with MRI at 12 months after surgery. Numerical data were analyzed for normal distribution with the Shapiro-Wilk test. Group comparison for numerical variables was performed by using Student’s t-test for normally distributed data, otherwise Mann-Whitney U-test was used. Categorical outcome (tendon integrity) was analyzed with the chi-squared test. Significance was set at P < .05.
The mean follow-up was 13 + 1.6 months. No patients were lost at the follow up. Comparison between groups did not show significant differences for baseline characteristics. At follow-up, mean CMS was 80.7 ± 16.6 points in group 1 and 91.5 ± 11.5 points in group 2 (p= 0.022). Mean DASH score was 28.6 ± 21.6 points in group 1 and 20.1 ± 17.4 points in group 2 (p= 0.178). Post-operative MRI at 12 months follow up showed 6 healed shoulder in Group 1 and 16 healed shoulder in Group 2 (p<0.004). No postoperative complications were reported in both groups.
The combination of nanofractures of the greater tuberosity, porcine dermal patch, and subsequent platelet rich plasma (PRP) subacromial injections is more effective than standard repair for the treatment of rotator cuff re-tears.