The clinical and radiologic outcome of microfracture on arthroscopic repair for full-thickness rotator cuff tear

Pulatkan, Anıl; Anwar, Wasim; Tokdemir, Sevil; Akpınar, Sercan; Bilsel, Kerem

doi:10.1016/j.jse.2019.07.010

Cited by 20 publications

(42 citation statements)

References 27 publications

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“…With this technique, the biology of the repair is enhanced with bone marrow vents created by microfracture of the greater trochanter, forming a crimson duvet or bone marrow superclot, which will envelop the repair site and regenerate the footprint of abductor tendons. 2,17…”

Section: Discussionmentioning

confidence: 99%

“…Pulatkan et al 17 examined 123 patients with full-thickness rotator cuff tears. Of this group, 44 were treated with SRM, and their retear rate was superior to that of patients undergoing SR and DR. Bilsel et al, 2 in a prospective randomized study, demonstrated that the rotator cuff tendon healing rate was 52.6% in patients in the SR group and 65.7% in the SRM group, which is a significant difference between groups.…”

Section: Discussionmentioning

confidence: 99%

“…A visual analog scale (VAS) for pain as well as the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) were used for evaluations both preoperatively and at a minimum 2-year follow-up (mean, 30 months [range, 24-42 months]). 1,17 MRI was used to diagnose and confirm retears in case of prolonged pain and persistent or recently developed weakness of abductor strength against resistance, and/or the Trendelenburg sign on physical examination at follow-up.…”

Section: Methodsmentioning

confidence: 99%

“…The biology of gluteus medius and minimus tendon repair could be enhanced with bone marrow vents created by microfracture of the greater trochanter, forming a ''crimson duvet'' or bone marrow superclot, which will envelop the repair site, similar to that seen with rotator cuff repair. 17 However, to date, the effectiveness and results of microfracture performed in conjunction with gluteus medius and minimus tendon repair have not been studied.…”

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confidence: 99%

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Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

et al. 2021

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Background: Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of adding microfracture to single-row repair (SR) on outcomes after the surgical repair of gluteus medius and minimus tendons and compare with SR and double-row repair (DR) without microfracture. We hypothesized that microfracture of the trochanteric footprint with SR would lead to superior clinical outcomes and lower clinically evident retear rates compared with SR and DR without the addition of microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 50 patients who underwent primary arthroscopic repair of hip gluteus medius and minimus tendon tears were investigated. Patients were divided into 3 groups: DR, 16 patients; SR, 14 patients; and SR with microfracture (SRM), 20 patients. Patients were evaluated with a visual analog scale (VAS) for pain as well as the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) both preoperatively and at a minimum 2-year follow-up (mean, 30 months). Results: Among the SR, SRM, and DR groups, the greatest decrease in VAS scores and increase in mHHS, HOS-ADL, and HOS-SS scores were seen in the SRM group, and all the differences were significant ( P < .001 to P = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the DR, SR, and SRM groups, respectively. Retear rates were lower in the SRM group compared with the SR and DR groups ( P = .042); however, there was no significant difference between the SR and DR groups ( P = .32) in terms of retear rates. Conclusion: Endoscopic SR with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than SR and DR without microfracture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

et al. 2021

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“…Many studies reported that the clinical outcome has been improved after surgery regarding pain relief and range of shoulder motion (14,(33)(34)(35)(36). The retear rate was reported regardless of the repair techniques (37)(38)(39). Therefore, efforts are still needed to improve the healing rate and to reduce the retear rate after rotator cuff repair surgery.…”

Section: Discussionmentioning

confidence: 99%

A biomechanical comparison of a mesh suture to a polyblend suture in a porcine tendon model

Wang¹,

Long²,

Li³

et al. 2021

Ann Transl Med

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Background: The suture-tendon interface turned out to be the weak point of a repaired rotator cuff. A double rip-stop (DRS) technique was developed to enhance the strength of the suture-tendon interface. The first aim of this study was to compare the suture-tendon interface strength between mesh suture and the No. 2 FiberWire (FW), which is commonly used in the clinic. The second aim was to compare the biomechanical properties of rotator cuff repair between mesh suture and No. 2 FiberWire using a typical suture-bridge (SB) and DRS techniques.Methods: Eighteen porcine subscapularis tendon (SST) was randomly assigned to the Mesh-tendon group and FiberWire-tendon group. A single suture loop was passed through the SST with a Mesh suture or FiberWire. Thirty-two infraspinatus tendons (ISTs) were randomly assigned to four groups: SB-Mesh group: SB technique with Mesh suture, SB-FW group: SB technique with FiberWire, DRS-Mesh group: DRS technique with Mesh suture, and DRS-FW group: DRS technique with FiberWire. All repaired specimens were underwent failure testing. Failure modes, load to create a 3-mm gap, failure load, and stiffness were compared.Results: There were no significant differences between the Mesh-tendon group and FiberWire-tendon group regarding the failure load, stiffness, and ultimate stress. When the same technique was used, the rotator cuff repaired with a mesh suture had the similar load to create a 3-mm gap, failure load, and stiffness compared with FiberWire. When the same suture was used, the DRS technique had a significantly higher load to create a 3-mm gap formation and failure load compared with the SB technique. Conclusions:The repair failure strength and stiffness using the mesh suture were similar to the FiberWire suture regardless of the repair techniques. However, the repair strength in the DRS technique was significantly stronger than the SB technique when the same suture material was used.

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Estrogen and testosterone supplementation improves tendon healing and functional recovery after rotator cuff repair

Tashjian,

Zitnay,

Kazmers

et al. 2023

Journal Orthopaedic Research

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Failure of healing after rotator cuff repair (RCR) is common. The purpose of the current study was to evaluate the effect of systemic estrogen or testosterone supplementation on tendon healing after RCR. Seventy‐two adult male mice were utilized for all experiments. The supraspinatus tendon was transected and repaired with 6‐0 Prolene suture on the left shoulder of 51 animals. Mice were segregated into three groups postoperative: (1) vehicle group (VG; n = 18), (2) estrogen group (EST; n = 17), and (3) testosterone group (TST; n = 16). An unrepaired control group (unrepaired, n = 21) did not have surgery. Utilizing these animals, histological analysis, activity testing, biomechanical testing and RNA sequencing (RNA‐seq) was performed. At 8 weeks post‐RCR, TST, and EST supplementation improved the overall histologic structure of the repaired enthesis site. No differences in ultimate failure loads or stiffness were detected between VG, EST, and TST groups after biomechanical testing. RCR caused a reduction in wheel activity compared to unrepaired controls and supplementation with TST restored wheel activity. RNA‐seq analysis indicated that estrogen and testosterone regulated different pathways associated with enthesis healing, including a suppression of inflammatory signaling. Supplementation with sex hormones improved the structure of the repaired tendon enthesis and significantly regulated expression of diverse pathways regulating multiple biological processes. Testosterone administration following RCR restored wheel activity without having a detrimental impact on biomechanical strength. Future human studies of sex hormone supplementation after RCR are warranted as supplementation in an animal model may improve tendon enthesis healing.

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The clinical and radiologic outcome of microfracture on arthroscopic repair for full-thickness rotator cuff tear

Cited by 20 publications

References 27 publications

Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

A biomechanical comparison of a mesh suture to a polyblend suture in a porcine tendon model

Estrogen and testosterone supplementation improves tendon healing and functional recovery after rotator cuff repair

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