Footprint preparation with nanofractures in a supraspinatus repair cuts in half the retear rate at 1-year follow-up. A randomized controlled trial

Abstract

Purpose To evaluate if adding nanofractures to the footprint of a supraspinatus tear repair would have any effect in the outcomes at one-year follow-up. Methods Multicentric, triple-blinded, randomized trial with 12-months follow-up. Subjects with isolated symptomatic reparable supraspinatus tears smaller than 3 cm and without grade 4 fatty infiltration were included. These were randomized to two groups: In the Control group an arthroscopic supraspinatus repair was performed; in the Nanofracture group the footprint was additionally prepared with nanofractures (1 mm wide, 9 mm deep microfractures). Clinical evaluation was done with Constant score, EQ-5D-3L, and Brief Pain Inventory. The primary outcome was the retear rate in MRI at 12-months follow-up. Secondary outcomes were: characteristics of the retear (at the footprint or at the musculotendinous junction) and clinical outcomes. Results Seventy-one subjects were randomized. Two were lost to follow-up, leaving 69 participants available for assessment at 12-months follow-up (33 in the Control group and 36 in the Nanofracture Group). The Nanofracture group had lower retear rates than the Control group (7/36 [19.4%] vs 14/33 [42.4%], differences significant, p = 0.038). Retear rates at the musculotendinous junction were similar but the Nanofracture group had better tendon healing rates to the bone (34/36 [94.4%] vs. 24/33 [66.71%], p = 0.014). Clinically both groups had significant improvements, but no differences were found between groups. Conclusion Adding nanofractures at the footprint during an isolated supraspinatus repair lowers in half the retear rate at 12-months follow-up. This is due to improved healing at the footprint. Level of evidence Level I.

Intraoperative Channeling in Arthroscopic Rotator Cuff Repair: A Multicenter Randomized Controlled Trial

“…Recently, Toro et al 23 conducted an RCT comparing intraoperative microfracture with a control, which also showed no statistical difference between groups in rotator cuff healing rates as well as Constant and ASES scores. A recent study by Ruiz Ibán et al 20 demonstrated a significantly lower retear rate of 19.4% in the nanofracture group versus 42.4% in the control group. In this latter study, a disposable device with a 1 mm–thick needle was used to perform microfracture.…”

“…The results of this study do not support our hypothesis that bone channeling at the time of rotator cuff repair results in a lower retear rate and superior functional outcomes. The channeling technique has been described using other terms in the literature including microfracture, 16,17 crimson duvet, 23 and nanofracture, 20 but the procedure is fundamentally the same. The instruments used in RCTs investigating intraoperative bone channeling in arthroscopic rotator cuff repair produce channels that range from 1 to 1.5 mm in width and from 3 to 9 mm in depth, making them similar to those used in the current study.…”

“…24 One possible approach to improve healing rates is to increase such growth factors and MSCs at the repair site by “channeling” the bone. Known by various terms in the literature, including “microfracture,” 16,17 “crimson duvet,” 23 and “nanofracture,” 20 this technique involves opening communication between bone marrow of the proximal humerus and the tendon insertion site. This method of drafting local autologous cells has a low cost; is technically simple; and perhaps most importantly recruits all available growth factors, cytokines, and stem cells rather than specific factors in isolation.…”

The Plug-Type Patch Results in Immediate and Postoperative Advantages in Graft-to-Bone Integration for Bridging Massive Rotator Cuff Tears in a Chronic Rabbit Model

“…Similarly, this special tunnel-based “footprint preparation” using bone tunnel with a larger refreshed bone bed contact area in the Plug-Pat may lead to an increased local outflow of stem cells and other cytokines from the bone marrow for better introduction to the healing interface, thus enhancing graft-to-bone healing. 12,14,25,34,39 Furthermore, the mechanical stimulation of tensile stress along the intratunnel graft tendon may be related to improved tenogenesis, intratendinous remodeling, and cell orientation at the graft-bone interface in the Plug-Pat. 3,8,32,55 Similar findings were observed in previous studies that compared these 2 fixations using the rotator cuff tendon or patellar tendon.…”

Roturas “irreparables” del manguito rotador: trucos y consejos para conseguir una reparación artroscópica

“…La creación de microperforaciones en la huella humeral antes de la reparación tendinosa permite mejorar el entorno biológico aportando un mayor flujo local de células madre y de otros factores que favorecen la cicatrización del tendón. 12 Sin embargo, esta técnica quedaría desaconsejada cuando la cabeza humeral es muy osteoporótica, porque existe el riesgo de debilitar aún más el hueso y producir una falla del anclaje del tendón al hueso.…”