Short-term Clinical Efficacy Of Arthroscopic Repair Of Great Full-thickness Rotator Cuff Tears By Biological Augmentation Technique

Purpose:To describe a novel biological augmentation technique of sub-microfracture along with a collagen scaffold in elderly patients with great full-thickness rotator cuff tears, and to evaluate its clinical outcomes and healing rates.Methods:40 patients with great full-thickness rotator cuff tears were received arthroscopic rotator cuff repair. They were randomly assigned to two groups. For group A (n=20), they were received traditional double-row rotator cuff repair. For group B (n=20), they were received a novel biological augmentation technique of sub-microfracture along with a collagen scaffold, based on the double-row technique. All patients completed follow-up of 12 months or more. Clinical outcomes were evaluated using Visual Analogue Score (VAS), UCLA and Constent scores at different follow-up points (1,3,6, and 12 months). Magnetic resonance imaging (MRI) images were performed in all cases at 1 week,6 and 12 months postoperatively to evaluate the integrity of rotator cuff and the retear rate of the repaired tendon at footprint site. Postoperatively, standard rehabilitation protocol was followed with gradual restoration.Results:All patients were followed-up for at least 12 months, the average follow-up period was 13.8±1.3 months. For group A, the mean UCLA score was significantly increased from 7.8±2.2 preoperatively to 27.4±2.0 at 12 months after surgery (p=0.0000). The mean Constent score was statistically significantly improved from 40.3±6.4 preoperatively to 84.8±4.8 at 12 months after operation (p=0.0000). In addition, VAS was significantly decreased from 5.4±1.2 preoperatively to 1.3±1.1 at 12 months postoperatively (p=0.0000). For group B, the UCLA score was increased from 8.8±2.8 preoperatively to 28.5±1.8 at 12 months after surgery (p=0.0000). The Constent score was significantly improved from 39.2±7.5 preoperatively to 88.1±6.1 at 12 months after operation (p=0.0000). In addition, VAS was decreased from 4.8±1.1 preoperatively to 1.2±1.0 at 12 months postoperatively (p=0.0000). There were no statistically significant difference between two groups. The retear rate was 5.8% at 12 months postoperatively as only one patient appeared partial retear by MRI imaging in group B, which was significant less than that in group A whose retear rate was 45%(p=0.03). Finally, there were no intraoperative or postoperative complications.Conclusion:Sub-microfracture along with a collagen scaffold could provide secure treatment of great full-thickness rotator cuff tears with substantial functional improvement and enhanced repaired structure healing in elderly patients.