Biopolar Radiofrequency-Based Microdebridement for Regractory Tendinosis of the Rotator Cuff Shows Equivalent Outcomes at One Year to Subacromial Decompression (SS-33)

Abstract

Subacromial decompression may not adequately address the degenerative process in refractory rotator cuff tendinosis. This study aimed to determine whether bipolar radiofrequency (bRF)-based microdebridement (microtenotomy) was effective for treating chronic supraspinatus tendinosis. Patients (30-70 years old) were considered for study enrollment provided they had failed six months active conservative treatment, and demonstrated Neer stage II impingement syndrome, positive X-ray evidence of Type II acromion, and MRI or ultrasound evidence of supraspinatus tendinosis. Patients were randomly assigned to undergo subacromial decompression (n=30) or bRF-based microdebridement (n=30). The bRF-based microdebridement treatment consisted of applying the bRF probe (TOPAZ) to the supraspinatous tendon only; patients received no associated subacromial decompression or bursectomy. Outcomes evaluation consisted of physical exam, self-reported pain using the visual analogue scale (VAS), and functional assessment (ASES, CON, UCLA). Statistical analyses were performed using factorial dependent measures ANOVA. Age and baseline VAS scores (mean±SD) were 52.0±6.7 and 53.2±6.6 years and 8.4±0.9 and 8.2±0.8 points for the bRF and subacromial decompression groups, respectively. Significant incremental postoperative reduction in pain (P=0.000) and improved function (P=0.000, all measures) were observed in both treatment groups. The bRF-treated group showed a similar longitudinal profile to the subacromial decompression group for pain relief (P=0.721) and function recovery (see Figure; ASES, P=0.703, CON, P=0.840, UCLA, P=0.704). At one year, median pain score was 1.0, and mean ASES, CON, and UCLA scores were >90, >85, and >30, respectively. Both procedures were associated with significant improvement over the one-year postoperative follow-up period but the less-invasive plasma-mediated bRF-based microdebridement procedure draws into question the need for a more extensive procedure such as subacromial decompression in the population of patients selected for this study.