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Riparazione della cuffia e microfratture fra i top 20 articoli del settore

Conclusioni della ricerca: la tecnica standardizzata di microfratture eseguite all’inserzione anatomia della cuffia (footprint) durante la riparazione artroscopica della cuffia può offrire riduzione del dolore post-operatorio senza portare a complicanze, ma non influenza i risultati funzionali valutati a minimo 2 anni di distanza dall’intervento.

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Kery Ernst

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Microfracture at the footprint top list on the demaim

Osti L, Del Buono A, Maffulli N, Microfractures at the rotator cuff footprint: a randomised controlled study. Int Orthop. 2013 Nov;37(11):2165-71



Microfractures at the footprint may be a potential additional source of growth factor and enhance the tendon healing at the bone-tendon junction when repairing rotator cuff tears.METHODS:

Fifty-seven patients who underwent shoulder arthroscopy for repair of complete rotator cuff tears were randomly divided into two groups, using a block randomisation procedure. Patients underwent microfracture at the footprint in the treatment group. The patients in the control group (n = 29) did not receive that treatment. All patients had the same post-operative rehabilitation protocol.

RESULTS: The two groups were homogeneous. There was a significant improvement from baseline to the last minimum follow-up of two years. At three months from the index procedure, visual analogue scale (VAS), range of motion (ROM) and University of California at Los Angeles (UCLA) and Constant scores were significantly better in group 1 than in group 2 (P < .05). At the last follow-up (minimum two years), clinical and functional outcomes were further improved in both the groups but inter-group differences were not significant. No technique-related complications were recorded.


Microfractures at the footprint are simple, safe, inexpensive and effective at producing less pain in the short term in patients who undergo rotator cuff repair, but at two years they do not result in significantly different outcomes, either clinically or at imaging, compared to traditional rotator cuff repair.

La classifica/ranking articoli sull’argomento di patologia della spalla a livello internazionale

1. Microfractures at the rotator cuff footprint: a randomised controlled study.

Osti L, Del Buono A, Maffulli N.

Int Orthop; 2013 Nov;37(11):2165-71.

2. Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up.

Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, Pripp AH, Smith HJ.

J Bone Joint Surg Am; 2014 Sep 17;96(18):1504-14.

3. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study.

Hernigou P, Flouzat Lachaniette CH, Delambre J, Zilber S, Duffiet P, Chevallier N, Rouard H.

Int Orthop; 2014 Sep;38(9):1811-8.

4. Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results.

Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, Aärimaa V.

Bone Joint J; 2014 Jan;96-B(1):75-81.

5. [Tangent sign - a reliable predictor of risk for tendon re-rupture in rotator cuff repair].

Smíd P, Hart R, Puskeiler M.

Acta Chir Orthop Traumatol Cech; 2014;81(3):227-32.

6. Is rotator cuff repair appropriate in patients older than 60 years of age? prospective, randomised trial in 103 patients with a mean four-year follow-up.

Jacquot A, Dezaly C, Goetzmann T, Roche O, Sirveaux F, Molé D, French Society for Shoulder, Elbow (SOFEC).

Orthop Traumatol Surg Res; 2014 Oct;100(6 Suppl):S333-8.

7. Advanced age diminishes tendon-to-bone healing in a rat model of rotator cuff repair.

Plate JF, Brown PJ, Walters J, Clark JA, Smith TL, Freehill MT, Tuohy CJ, Stitzel JD, Mannava S.

Am J Sports Med; 2014 Apr;42(4):859-68.

8. Rehabilitation following arthroscopic rotator cuff repair: a prospective randomized trial of immobilization compared with early motion.

Keener JD, Galatz LM, Stobbs-Cucchi G, Patton R, Yamaguchi K.

J Bone Joint Surg Am; 2014 Jan 1;96(1):11-9.

9. Pulsed electromagnetic fields after rotator cuff repair: a randomized, controlled study.

Osti L, Buono AD, Maffulli N.

Orthopedics; 2015 Mar;38(3):e223-8.

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

Bonnevialle N, Bayle X, Faruch M, Wargny M, Gomez-Brouchet A, Mansat P.

J Shoulder Elbow Surg; 2015 Aug;24(8):1257-62.

11. [Use of Cultured Human Autologous Bone Marrow Stem Cells in Repair of a Rotator Cuff Tear: Preliminary Results of a Safety Study].

Havlas V, Kotaška J, Koníček P, Trč T, Konrádová Š, Kočí Z, Syková E.

Acta Chir Orthop Traumatol Cech; 2015;82(3):229-34.

12. Rotator cuff tears in young patients: a different disease than rotator cuff tears in elderly patients.

Lazarides AL, Alentorn-Geli E, Choi JH, Stuart JJ, Lo IK, Garrigues GE, Taylor DC.

J Shoulder Elbow Surg; 2015 Nov;24(11):1834-43.

13. Clinical outcomes of rotator cuff repair with arthroscopic capsular release and manipulation for rotator cuff tear with stiffness: a matched-pair comparative study between patients with and without stiffness.

Cho CH, Jang HK, Bae KC, Lee SW, Lee YK, Shin HK, Hwang I.

Arthroscopy; 2015 Mar;31(3):482-7.

14. Is arthroscopic distal clavicle resection necessary for patients with radiological acromioclavicular joint arthritis and rotator cuff tears? A prospective randomized comparative study.

Oh JH, Kim JY, Choi JH, Park SM.

Am J Sports Med; 2014 Nov;42(11):2567-73.

15. Protocol for the United Kingdom Rotator Cuff Study (UKUFF): a randomised controlled trial of open and arthroscopic rotator cuff repair.

Carr AJ, Rees JL, Ramsay CR, Fitzpatrick R, Gray A, Moser J, Dawson J, Bruhn H, Cooper CD, Beard DJ, Campbell MK.

Bone Joint Res; 2014 May;3(5):155-60.

16. Three-dimensional analysis of acromial morphologic characteristics in patients with and without rotator cuff tears using a reconstructed computed tomography model.

Fujisawa Y, Mihata T, Murase T, Sugamoto K, Neo M.

Am J Sports Med; 2014 Nov;42(11):2621-6.

17. Efficacy of surgery for rotator cuff tendinopathy: a systematic review.

Toliopoulos P, Desmeules F, Boudreault J, Roy JS, Frémont P, MacDermid JC, Dionne CE.

Clin Rheumatol; 2014;33(10):1373-83.

18. Preoperative factors affecting footprint coverage in rotator cuff repair.

Koh KH, Lim TK, Park YE, Lee SW, Park WH, Yoo JC.

Am J Sports Med; 2014 Apr;42(4):869-76.

19. Self-managed loaded exercise versus usual physiotherapy treatment for rotator cuff tendinopathy: a pilot randomised controlled trial.

Littlewood C, Malliaras P, Mawson S, May S, Walters SJ.

Physiotherapy; 2014 Mar;100(1):54-60.

20. Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years.

Gerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK.

J Bone Joint Surg Am; 2013 Nov 6;95(21):1920-6.