Treatment of rotator cuff intrasubstance tears with autologous blood injections; a novel treatment using ultrasound guidance

Abstract

Purpose Assessment of sonographic guided autologous blood injections (ABI) as an effective minimally invasive treatment for rotator cuff interstitial delamination tears which are problematic to treat and difficult to diagnose by arthroscopy. Methods and materials Forty-two patients with clinical suspicion of rotator cuff tear underwent magnetic resonance imaging (MRI). Confirmed cases of supraspinatus longitudinal split tear were prospectively enrolled in the study and had ultrasound (US) assessment to characterise echotexture, interstitial tearing and neovascularity. Individuals randomised into two groups; first group (21 patients, age 18–45) received standard treatment with 3 millilitres (ml) Bupivacaine and 40 milligrams (mg) triamcinolone into the subacromial-subdeltoid (SASD) bursa. The second group (21 patients, age 19–50) received standard therapy and ABI into the site of fibrillar discontinuity. We performed two injections and sonographically monitored any tendon changes. Pain scores and functional improvement assessed with Oxford Shoulder Score (OSS). Results Pre-procedural, ten days, six weeks, three, 12 and 18 month post-procedure OSS were compared. Changes in echogenicity, neovascularity and interstitial tear size noted. Patients in the ABI group showed statistical and clinical long-term pain relief and functional improvement as assessed by the overall OSS. Conclusion ABI appears to be a viable alternative and more clinically effective when compared to standard steroid injection therapy for rotator cuff delamination tearing. Assessment of sonographic guided autologous blood injections (ABI) as an effective minimally invasive treatment for rotator cuff interstitial delamination tears which are problematic to treat and difficult to diagnose by arthroscopy. Forty-two patients with clinical suspicion of rotator cuff tear underwent magnetic resonance imaging (MRI). Confirmed cases of supraspinatus longitudinal split tear were prospectively enrolled in the study and had ultrasound (US) assessment to characterise echotexture, interstitial tearing and neovascularity. Individuals randomised into two groups; first group (21 patients, age 18–45) received standard treatment with 3 millilitres (ml) Bupivacaine and 40 milligrams (mg) triamcinolone into the subacromial-subdeltoid (SASD) bursa. The second group (21 patients, age 19–50) received standard therapy and ABI into the site of fibrillar discontinuity. We performed two injections and sonographically monitored any tendon changes. Pain scores and functional improvement assessed with Oxford Shoulder Score (OSS). Pre-procedural, ten days, six weeks, three, 12 and 18 month post-procedure OSS were compared. Changes in echogenicity, neovascularity and interstitial tear size noted. Patients in the ABI group showed statistical and clinical long-term pain relief and functional improvement as assessed by the overall OSS. ABI appears to be a viable alternative and more clinically effective when compared to standard steroid injection therapy for rotator cuff delamination tearing.