title: Does microvascularization of the footprint play a role in rotator cuff healing of the shoulder?
abstract: BACKGROUND
  The aim of the study was to evaluate the relationship between bone microvascularization of the footprint and tendon integrity after rotator cuff repair of the shoulder.
  
  
  METHODS
  Forty-eight patients (mean age, 59 years; ±7.9) with a chronic rotator cuff tear underwent a tendon repair with a single-row technique and were studied prospectively. A core obtained from the footprint during the procedure allowed determination of the bone's microvascularization with an immunohistochemistry technique using anti-CD34 antibodies. Clinical evaluation was performed at a minimum of 12-month follow-up, and rotator cuff integrity was assessed with ultrasound according to Sugaya's classification.
  
  
  RESULTS
  At a mean follow-up of 13 months, the Constant score improved from 40 to 75 points; American Shoulder and Elbow Surgeons score, from 59 to 89 points; and subjective shoulder value, from 38% to 83% (P < .001). Ultrasound identified 18 patients with Sugaya type I healing, 27 patients with type II, and 3 patients with type IV. No patients showed Sugaya type III or V repairs. The rate of microvascularization of the footprint was 15.6%, 13.9%, and 4.2% for type I, II, and IV tendon integrity, respectively (I vs. II, P = .22; II vs. IV, P = .02; I vs. IV, P = .0022). Patients with a history of corticosteroid injection had a lower rate of microvascularization than the others (10.3% vs. 16.2%; P = .03).
  
  
  CONCLUSIONS
  Even if overall satisfactory clinical outcomes are achieved after a rotator cuff repair, bone microvascularization of the footprint plays a role in rotator cuff healing. A lower rate of microvessels decreases the tendon integrity and healing potential after repair.
authors.affiliation: Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Purpan, Toulouse, France. Electronic address: nicolasbonnevialle@yahoo.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonnevialle
authors.affiliation: Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Purpan, Toulouse, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bayle
authors.affiliation: Department of Radiology, Centre Hospitalier Universitaire de Purpan, Toulouse, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Faruch
authors.affiliation: Department of Epidemiology and Public Health, Centre Hospitalier Universitaire de Purpan, Toulouse, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Wargny
authors.affiliation: Department of Pathology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Gomez-Brouchet
authors.affiliation: Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Purpan, Toulouse, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mansat
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D017006:Rotator Cuff / Q000473:pathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000601:surgery; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Bone; microvascularization; retear; rotator cuff tear; shoulder