title: Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair: a prospective randomized study.
abstract: OBJECTIVE
  To evaluate the efficacy of a marrow-stimulating technique with microfractures of the greater tuberosity during arthroscopic rotator cuff repair.
  
  
  METHODS
  Eighty patients with a full-thickness rotator cuff tear underwent an arthroscopic single-row repair. Patients were divided into 2 groups of 40 cases each. In group 1, standard repair was performed; in group 2, microfractures of the greater tuberosity were performed to enhance tendon repair. Clinical outcome was assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) score and normalized Constant score. Tendon integrity was assessed with magnetic resonance imaging. Multivariate analysis was performed to determine which predictors were independently associated with the outcome. Significance was set at P < .05.
  
  
  RESULTS
  The mean follow-up was 28.1 ± 3 months. Seven patients were lost to follow-up (2 in group 1 and 5 in group 2). Comparison between groups did not show significant differences for baseline characteristics. The mean DASH score was 28.6 ± 21.3 points in group 1 and 23.3 ± 20.1 points in group 2. Although the difference was not statistically significant, the confidence interval included a 10-point value (minimal clinically important difference) in favor of the microfracture group. The difference in the Constant score between groups was not significant. The tendon healing rate was 52.6% in group 1 and 65.7% in group 2, without a significant difference between groups. Subgroup analysis for tear size showed that group 2 had a significantly greater healing rate than group 1 for large tears (P = .040). Multivariate analysis showed that age, timing of symptoms, tear location, tendon retraction, and fatty infiltration significantly affected the outcomes.
  
  
  CONCLUSIONS
  Postoperative magnetic resonance imaging did not show any significant difference between groups in structural integrity. However, subgroup analysis showed a significantly greater healing rate in the microfracture group for large tears involving the supraspinatus and infraspinatus.
  
  
  METHODS
  Level I, high-quality randomized controlled trial with no statistically significant difference but narrow confidence intervals.
authors.affiliation: Department of Orthopaedics and Traumatology, Catholic University, Rome, Italy. giuseppe.milano@rm.unicatt.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milano
authors.forename: Maristella F
authors.initials: MF
authors.lastname: Saccomanno
authors.forename: Silvia
authors.initials: S
authors.lastname: Careri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Taccardo
authors.forename: Rocco
authors.initials: R
authors.lastname: De Vitis
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbriciani
mesh_terms: D000368:Aged; D054544:Arthroplasty, Subchondral; D001182:Arthroscopy; D001853:Bone Marrow / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D016037:Single-Blind Method; D016896:Treatment Outcome; D014945:Wound Healing