Footprint preparation with nanofractures in a supraspinatus repair cuts in half the retear rate at 1-year follow-up. A randomized controlled trial

Knee Surg Sports Traumatol Arthrosc. 2021 Jul;29(7):2249-2256. doi: 10.1007/s00167-020-06073-7. Epub 2020 Jun 1.

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.

Results: Seventy-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 evidence: Level I.

Keywords: Footprint preparation; Microfracture; Rotator cuff; Rotator cuff repair; Rotator cuff retear; Shoulder; Shoulder arthroscopy; Supraspinatus tear.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Arthroscopy / methods*
  • Female
  • Follow-Up Studies
  • Fractures, Stress / surgery
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Plastic Surgery Procedures / methods
  • Reinjuries / epidemiology*
  • Rotator Cuff / surgery
  • Rotator Cuff Injuries / surgery*
  • Rupture / surgery
  • Suture Techniques
  • Tendons / surgery
  • Treatment Outcome