Shoulder
Does microvascularization of the footprint play a role in rotator cuff healing of the shoulder?

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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.

Section snippets

Study design and patients

This prospective study was conducted in our department from January 2012 to January 2013. Inclusion criteria were patients who underwent a primary rotator cuff repair of supraspinatus or infraspinatus tendon tears after a failed conservative treatment with an open or an arthroscopic single-row technique and who agreed to intraoperative bone sampling and ultrasound assessment of cuff integrity at follow-up.

Exclusion criteria were prior surgical procedure on the shoulder and degenerative or

Results

The mean follow-up was 12.7 months (range, 12-17). Baseline epidemiologic data and characteristics of tear are reported in Table I. The results indicated that Constant score, ASES score, and SSV score increased significantly at last follow-up (Table II).

Discussion

This study was based on anti-CD34 antibodies, which are commonly used to assess angiogenesis in human solid tumors.11, 22 The rate of the microvascularization was highly variable (range, 2%-33%) and was correlated with preoperative steroid injection. Moreover, this study demonstrated that the rate of retear (Sugaya type IV) after rotator cuff repair was associated with poorer microvascularization of the bone at the reinsertion site onto the greater tuberosity.

Many authors have previously

Limitations

This study has several limitations. Because the immunohistochemistry technique using anti-CD34 antibodies has not been previously evaluated in healthy tissue, the findings of this study could be questioned. Another limitation is the short follow-up regarding clinical and morphologic assessment of the rotator cuff repair. However, first, the main goal of this study was to correlate tendon integrity with microvascularization of the footprint; and second, it was reported that retears occurred most

Conclusions

Microvascularization of the greater tuberosity footprint of rotator cuff tears ranged from 2% to 33%. Preoperative corticosteroid injections seem to lower the rate of bone microvessels. 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 at 12-month follow-up.

Disclaimer

The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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    Institutional Review Board approval was provided by Comité d'Ethique de la Recherche des Hôpitaux de Toulouse: No. 17-0313.

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