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. 2023 Aug 29;11(8):23259671231190335.
doi: 10.1177/23259671231190335. eCollection 2023 Aug.

Arthroscopic Biological Augmentation With Subacromial Bursa for Bursal-Sided Partial-Thickness Rotator Cuff Tears

Yasin Güler  1 , Ahmet Keskin  2 , Mustafa Yerli  3 , Yunus Imren  1 , Bulent Karslıoglu  3 , Suleyman Semih Dedeoglu  1
Affiliations

Arthroscopic Biological Augmentation With Subacromial Bursa for Bursal-Sided Partial-Thickness Rotator Cuff Tears

Yasin Güler et al. Orthop J Sports Med. .

Abstract

Background: Augmentation with subacromial bursa has not been fully established in bursal-sided partial-thickness rotator cuff tears (PT-RCTs).

Purpose: To compare the results of acromioplasty + arthroscopic debridement versus acromioplasty + augmentation with subacromial bursa for Ellman type 2 PT-RCTs involving 25% to 50% of the tendon surface area.

Study design: Cohort study; Level of evidence, 3.

Methods: Included were 40 patients (mean age, 47.8 years) with Ellman type 2 PT-RCTs whose symptoms did not regress despite 3 months of nonoperative treatment. The patients underwent either acromioplasty + debridement (group A; n = 18) or acromioplasty + augmentation (group B; n = 22). Outcome scores (visual analog scale [VAS] pain score, Constant-Murley score [CMS], and American Shoulder and Elbow Surgeons [ASES] score) were obtained preoperatively and at 6, 12, and 18 months postoperatively. Magnetic resonance imaging (MRI) scans performed at 6 months postoperatively were used to determine the integrity and state of healing.

Results: There were no significant differences between groups A and B in preoperative VAS, CMS, or ASES scores, and patients in both groups saw significant improvement at each follow-up time point on all 3 outcome scores (P = .001 for all). Scores on all 3 outcome measures were significantly better in group B than group A at each postoperative time point (P < .05 for all). Postoperative MRI scans revealed persistent partial tears in 5 of 18 patients in group A compared with 2 of 22 patients in group B (P < .05). Conversion to full-thickness tear (3/18 patients) was seen only in group A.

Conclusion: Patients who underwent biological augmentation of their PT-RCTs had improved outcome scores compared with those treated with acromioplasty and debridement alone.

Keywords: bursal side; full thickness; partial thickness; rotator cuff; subacromial bursa.

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Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flowchart of patient inclusion. PT-RCT, partial-thickness rotator cuff tear.
Figure 2.
Figure 2.
Posterolateral viewing portal showing the bursal tissue (*) and partial-thickness rotator cuff tear (**). The probe (X) was introduced from the anterior portal.
Figure 3.
Figure 3.
Posterolateral viewing portal showing subacromial bursa harvesting with the help of a radiofrequency device introduced from the anterior portal.
Figure 4.
Figure 4.
Arthroscopic images from the lateral viewing portal. (A) Passing the carrier suture through the bursa and (B) taking the carrier suture passed through the bursa with a grasper device (device from anterolateral portal). (C) Carrier suture passed through the bursa (*). (D) High-strength suture passing through the bursa (suture from anterolateral portal).
Figure 5.
Figure 5.
(A) High-strength suture that fixes bursa is loaded to knotless anchor. (B) Placing the anchor on which the high-strength suture is loaded. (C) Appearance of bursal-sided partial rotator cuff tear after covered with a bursa (*). Lateral viewing portal, anchor from anterolateral portal.
See this image and copyright information in PMC

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