JSES - 2026-07-16 - Journal Article
Effect of Combined Tendon Remnant Preservation and Bone Marrow Stimulation on Rotator Cuff Healing: A Propensity Score-Matched Study.
Scaini A, Maggini E, Daffara V, Guizzi A, Bergomi A, Milano G
Topics
Key Takeaway
Combined tendon remnant preservation and 1mm nanofracture bone marrow stimulation improved MRI-confirmed healing rate from 53.8% to 80.8% (p=0.039) without significant difference in clinical outcome scores.
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Summary
This study evaluated whether combining tendon remnant preservation with 1mm-diameter nanofracture bone marrow stimulation of the greater tuberosity improves healing after arthroscopic rotator cuff repair compared to standard repair with debridement and cortical abrasion. Propensity score matching balanced 52 patients across groups; MRI at 6 months showed healing in 80.8% of the index group vs. 53.8% of controls (p=0.039). Despite the structural advantage, ASES, QuickDASH, and WORC scores improved significantly in both groups with no between-group difference.
Key Limitation
With only 26 patients per group, the study is substantially underpowered to detect clinically meaningful differences in patient-reported outcomes, and the 6-month MRI endpoint may not reflect final healing status.
Original Abstract
INTRODUCTION
Arthroscopic rotator cuff repair provides satisfactory functional results. However, imaging studies show a high healing failure rate. Recent studies on animal models evaluated the effect of preserving the tendon remnant of the rotator cuff on tendon healing, showing a positive impact by combining tendon remnant preservation and small bone vents on the greater tuberosity. The study aimed to evaluate the efficacy of a combined biologic augmentation technique consisting of tendon remnant preservation on the rotator cuff footprint and bone marrow stimulation of the greater tuberosity.
MATERIALS AND METHODS
Patients who underwent arthroscopic rotator cuff repair associated with small-diameter bone marrow stimulation holes, 1 mm in diameter (nanofractures) and tendon footprint preservation were included. Standard arthroscopic rotator cuff repairs were used as controls. The primary outcome was subjective functional assessment with the American Shoulder and Elbow Surgeons (ASES) Score. Secondary patient-reported outcomes were the short version of the Disability of the Arm, Shoulder and Hand (Quick-DASH) scale and the Western Ontario Rotator Cuff (WORC) Index, and structural integrity of repaired tendons by magnetic resonance imaging (MRI) performed six months after surgery. Significance tests were run to assess differences between groups for baseline characteristics and at follow-up. Statistical Significance was set at p < 0.05.
RESULTS
The study included 52 patients (26 in each group). The mean age of patients was 64.8±6.9 years. Mean follow-up was 42.3±6.6 months. No significant differences between groups for baseline characteristics were found. Comparison between pre- and postoperative functional scores showed significant improvement at follow-up in both groups (p<0.001). No significant differences between groups were observed for primary and secondary clinical outcomes. Structural integrity was assessed in all the patients included. Significant difference between groups was observed in favor of the index group. Tendon healed in 14 (53.8%) and in 21 (80.8%) in the control and index group, respectively (p=0.039).
CONCLUSIONS
Preservation of rotator cuff tendon remnant combined with small bone vents of the greater tuberosity during arthroscopic rotator cuff repair provided significant improvements in tendon healing rate compared to arthroscopic rotator cuff repair with soft tissue debridement and cortical abrasion of the greater tuberosity.
LEVEL OF EVIDENCE
Level III; Retrospective Cohort Comparison; Treatment Study.