Subacromial bursa augmentation in arthroscopic rotator cuff repair: Clinical and doppler ultrasound assessment-A preliminary study

Florian Freislederer; Mara Dimitriu; David Endell; Laurent Audigé; Daniela Brune; Marco Etter; Markus Scheibel

doi:10.1002/jeo2.70714

Subacromial bursa augmentation in arthroscopic rotator cuff repair: Clinical and doppler ultrasound assessment-A preliminary study

J Exp Orthop. 2026 May 12;13(2):e70714. doi: 10.1002/jeo2.70714. eCollection 2026 Apr.

Authors

Florian Freislederer¹, Mara Dimitriu¹, David Endell¹, Laurent Audigé^{2

3}, Daniela Brune², Marco Etter⁴, Markus Scheibel^{1

5}

Affiliations

¹ Department of Shoulder and Elbow Surgery Schulthess Klinik Zürich Switzerland.
² Department of Research and Development Schulthess Klinik Zürich Switzerland.
³ Department of Clinical Research University Hospital Basel and University of Basel, Surgical Outcome Research Center Basel Switzerland.
⁴ Department of Rheumatology Schulthess Klinik Zürich Switzerland.
⁵ Charité-Universitaetsmedizin Berlin, CMSC Center for Musculoskeletal Surgery Berlin Germany.

Abstract

Purpose: To determine whether augmentation with the subacromial bursa influences postoperative tendon healing, particularly regarding morphology and vascularity, after arthroscopic rotator cuff repair.

Methods: In this prospective comparative study (2019-2023), patients with crescent-shaped posterosuperior rotator cuff tears (SSP ± ISP, Lafosse ≤ 1), tendon retraction Patte ≤ 2, and fatty infiltration Goutallier ≤ 2 underwent double-row arthroscopic repair with (Bursa Group) or without (Control Group) bursa augmentation. Postoperative vascularity and tendon integrity were assessed via Doppler ultrasound at 3, 6, 12 and 24 weeks. Secondary outcomes included pain and functional scores.

Results: Thirty patients (mean age 60) were analysed: 20 in the Bursa Group and 10 in the Control Group. The Bursa Group showed an initial increase in bursal vascularity at 3 weeks, which declined similarly in both groups thereafter. At 6 weeks, neovascularity at the tendon insertion showed an increase in the Bursa Group, while it significantly decreased in controls (p = 0.032). Pain scores were lower in the Bursa Group, with statistically significant but small differences at 6 weeks at rest (mean VAS 1 ± 1 vs. 3 ± 2, p = 0.013) and at 3 months during activity (mean VAS 3 ± 2 vs. 5 ± 2, p = 0.009), while no significant differences were observed at other time points. Tendon thickness was better preserved in Group B at 3 (p = 0.029) and 6 months (p = 0.007). Functional outcomes were comparable after 6 months. Three retears occurred in Group B, while no retears were observed in Group C.

Conclusion: Clinical outcomes were similar between bursa-augmented rotator cuff repair and the control group. While bursa augmentation did not enhance neovascularization compared to controls, it was associated with better tendon thickness preservation and reduced pain, although these differences were marginal and limited to selected early follow-up time points.

Level of evidence: Level III, evidence study.

Keywords: bursa augmentation; rotator cuff repair; tendon healing; tendon thickness; ultrasound Doppler.