title: Bone marrow stimulation at the footprint of arthroscopic surface-holding repair advances cuff repair integrity.
abstract: BACKGROUND
  Bone marrow stimulation (BMS) at the footprint of arthroscopic rotator cuff repair has not been fully evaluated according to the preoperative tear size and surgical technique. In this study, we investigated the effect of BMS on cuff repair integrity after an arthroscopic surface-holding (ASH) repair.
  
  
  METHODS
  A total of 111 patients (mean age, 64.5 years) with chronic rotator cuff tears who underwent treatment by the ASH method with BMS by drilling of multiple holes at the footprint (67 shoulders) or without BMS (44 shoulders) were studied, and all patients were observed prospectively. Sugaya's classification was used to evaluate cuff integrity by postoperative magnetic resonance imaging, with types IV and V classified as rotator cuff retears.
  
  
  RESULTS
  The mean scores for cuff integrity were 2.2 ± 0.2 and 1.7 ± 0.2 in the non-BMS and BMS groups, respectively. The mean scores were similar between the 2 groups for medium tears; however, scores for large-massive tears were significantly lower in the BMS group. The overall retear rate was 23.9% in the non-BMS group and 9.1% in the BMS group, and the distribution of repair types differed significantly. For large-massive tears, the retear rate was much higher in the non-BMS group (28.6%) than in the BMS group (4.5%), although the rates for medium tears were comparable between the 2 groups.
  
  
  CONCLUSIONS
  These findings demonstrate that applying BMS to the footprint during ASH repair results in improved cuff repair integrity, particularly in large-massive tears, and suggest the importance of biologic treatment for rotator cuff healing after arthroscopic rotator cuff repair.
authors.affiliation: Department of Orthopaedic Surgery, University of Miyazaki, Miyazaki, Japan; Institute of Medical Science, Tokyo Medical University, Tokyo, Japan. Electronic address: nobutanigu@gmail.com.
authors.forename: Noboru
authors.initials: N
authors.lastname: Taniguchi
authors.affiliation: Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Suenaga
authors.affiliation: Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Oizumi
authors.affiliation: Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Miyoshi
authors.affiliation: Rehabilitation Clinic Yamaguchi, Naha, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamaguchi
authors.affiliation: Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Orthopaedic Surgery, University of Miyazaki, Miyazaki, Japan.
authors.forename: Etsuo
authors.initials: E
authors.lastname: Chosa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000379:methods*; D001853:Bone Marrow / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059630:Mesenchymal Stem Cells / Q000502:physiology; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Bone marrow stimulation; arthroscopic rotator cuff repair; biologic healing; cuff repair integrity; mesenchymal stem cells; surface-holding technique