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.ResultsSeventy-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 evidenceLevel I.
Highlights
ParticipantsRotator cuff tears are one of the most frequent causes of pain and disfunction in the older adult population [13]
Two subjects did not fulfil the 1 year follow up: one decided that he wanted to be withdrawn from the study at the 3 month follow-up visit and another did not come to the 1 month visit and was lost to follow-up
Milano et al [14] and Osti et al [15] performed two randomized controlled trials to evaluate the efficacy of microfractures at the footprint during rotator cuff repair but did not find differences in structural healing or functional outcomes at 1 year
Summary
Rotator cuff tears are one of the most frequent causes of pain and disfunction in the older adult population [13]. Many rotator cuff tears can be dealt conservatively, some of them require surgical repair [1]. Despite advances in surgical technique, the retear rates are often over 20% [10]. This high incidence of repair failure is due to fundamental biological issues related to the difficulty to obtain consistent tendon-to-bone healing and the unstoppable development of tendon degeneration [4]. Improving the biological environment using platelet-rich plasma [11] or stem cells [20] might increase the healing rate marginally
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
