Sunday, November 13, 2016

Rotator cuff repair - where does the blood flow come from?

Difference in vascular patterns between transosseous-equivalent and transosseous rotator cuff repair.

These authors randomized 21 shoulders in 20 patients undergoing arthroscopic rotator cuff repair into 2 groups: transosseous-equivalent repair (TOE group, n = 10) and transosseous repair (TO group, n = 11). Blood flow in 4 regions inside the cuff (lateral articular, lateral bursal, medial articular, and medial bursal), in the knotless suture anchor in the TOE group, and in the bone tunnel in the TO group was measured using contrast-enhanced ultrasound at 1 month, 2 months, 3 months, and 6

The sequential vascular pattern inside the repaired rotator cuff was different between groups. The blood flow in the lateral articular area at 1 month, 2 months, and 3 months (P = .002, .005, and .025) and that in the lateral bursal area at 2 months (P = .031) in the TO group were significantly greater than those in the TOE group postoperatively. 

Blood flow was significantly greater for the bone tunnels in the TO group than for the knotless suture anchor in the TOE group at 1 month and 2 months postoperatively (P = .041 and .009).

They concluded that sequential vascular pattern inside the repaired rotator cuff depends on the suture technique used. Bone tunnels through the footprint may contribute to biologic healing by increasing blood flow in the repaired rotator cuff.

Comment:   The authors did not find differences in the clinical outcomes between the two groups. They are careful to point out that the relationship between blood flow and rotator cuff healing has not been elucidated.

Nevertheless, this study provides support for the idea that the vascularity in healing cuff repairs comes from the bone and not the tendon.