International Orthopaedics

, Volume 37, Issue 11, pp 2165–2171 | Cite as

Microfractures at the rotator cuff footprint: a randomised controlled study

  • Leonardo Osti
  • Angelo Del Buono
  • Nicola MaffulliEmail author
Original Paper



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.


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.


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.


Rotator cuff Repair Cuff footprint Microfractures Randomised controlled trial 


Conflict of interest

The authors declare that they have no conflict of interest


  1. 1.
    Murray TF, Lajtai G, Mileski RM, Snyder SJ (2002) Arthroscopic repair of medium to large full-thickness rotator cuff tears: outcome at 2- to 6-year follow-up. J Shoulder Elbow Surg 11:19–24PubMedCrossRefGoogle Scholar
  2. 2.
    Kovacevic D, Rodeo SA (2008) Biological augmentation of rotator cuff tendon repair. Clin Orthop Relat Res 466:622–633PubMedCrossRefGoogle Scholar
  3. 3.
    Papalia R, Del Buono A, Leonardi F, Osti L, Maffulli N, Denaro V (2011) Creatinine and nonprotein nitrogen plasma levels: possible etiopathogenetic factors in rotator cuff tears. Phys Sportsmed 39:127–132PubMedCrossRefGoogle Scholar
  4. 4.
    Papalia R, Franceschi F, Del Buono A, Maffulli N, Denaro V (2011) Results of surgical management of symptomatic shoulders with partial thickness tears of the rotator cuff. Br Med Bull 99:141–154PubMedCrossRefGoogle Scholar
  5. 5.
    Osti L, Papalia R, Del Buono A, Denaro V, Maffulli N (2010) Comparison of arthroscopic rotator cuff repair in healthy patients over and under 65 years of age. Knee Surg Sports Traumatol Arthrosc 18:1700–1706PubMedCrossRefGoogle Scholar
  6. 6.
    Lohr JF, Uhthoff HK (1990) The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res 35–38Google Scholar
  7. 7.
    Gulotta LV, Rodeo SA (2009) Growth factors for rotator cuff repair. Clin Sports Med 28:13–23PubMedCrossRefGoogle Scholar
  8. 8.
    Fealy S, Adler RS, Drakos MC, Kelly AM, Allen AA, Cordasco FA, Warren RF, O’Brien SJ (2006) Patterns of vascular and anatomical response after rotator cuff repair. Am J Sports Med 34:120–127PubMedCrossRefGoogle Scholar
  9. 9.
    Randelli P, Margheritini F, Cabitza P, Dogliotti G, Corsi MM (2009) Release of growth factors after arthroscopic acromioplasty. Knee Surg Sports Traumatol Arthrosc 17:98–101PubMedCrossRefGoogle Scholar
  10. 10.
    Chahal J, Van Thiel GS, Mall N, Heard W, Bach BR, Cole BJ, Nicholson GP, Verma NN, Whelan DB, Romeo AA (2012) The role of platelet-rich plasma in arthroscopic rotator cuff repair: a systematic review with quantitative synthesis. Arthroscopy 28:1718–1727PubMedCrossRefGoogle Scholar
  11. 11.
    Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484PubMedCrossRefGoogle Scholar
  12. 12.
    Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24:106–112PubMedCrossRefGoogle Scholar
  13. 13.
    Hildebrand KA, Woo SL, Smith DW, Allen CR, Deie M, Taylor BJ, Schmidt CC (1998) The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament. An in vivo study. Am J Sports Med 26:549–554PubMedGoogle Scholar
  14. 14.
    Del Buono A, Oliva F, Longo UG, Rodeo SA, Orchard J, Denaro V, Maffulli N (2012) Metalloproteases and rotator cuff disease. J Shoulder Elbow Surg 21:200–208PubMedCrossRefGoogle Scholar
  15. 15.
    Del Buono A, Oliva F, Osti L, Maffulli N (2013) Metalloproteases and tendinopathy. Muscles Ligaments Tendons J 3:51–57Google Scholar
  16. 16.
    Mazzocca AD, McCarthy MB, Chowaniec D, Cote MP, Judson CH, Apostolakos J, Solovyova O, Beitzel K, Arciero RA (2011) Bone marrow-derived mesenchymal stem cells obtained during arthroscopic rotator cuff repair surgery show potential for tendon cell differentiation after treatment with insulin. Arthroscopy 27:1459–1471PubMedCrossRefGoogle Scholar
  17. 17.
    Dopirak R, Bond JL, Snyder SJ (2007) Arthroscopic total rotator cuff replacement with an acellular human dermal allograft matrix. Int J Shoulder Surg 1:7–15CrossRefGoogle Scholar
  18. 18.
    Franceschi F, Papalia R, Del Buono A, Vasta S, Costa V, Maffulli N, Denaro V (2013) Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial. Int Orthop. doi: 10.1007/s00264-013-1882-9
  19. 19.
    Franceschi F, Papalia R, Palumbo A, Del Buono A, Maffulli N, Denaro V (2012) Operative management of partial- and full-thickness rotator cuff tears. Med Sport Sci 57:100–113PubMedCrossRefGoogle Scholar
  20. 20.
    Franceschi F, Papalia R, Del Buono A, Maffulli N, Denaro V (2011) Repair of partial tears of the rotator cuff. Sports Med Arthrosc 19:401–408PubMedCrossRefGoogle Scholar
  21. 21.
    Milano G, Saccomanno MF, Careri S, Taccardo G, De Vitis R, Fabbriciani C (2013) Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair: a prospective randomized study. Arthroscopy 29:802–810PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Leonardo Osti
    • 1
  • Angelo Del Buono
    • 1
  • Nicola Maffulli
    • 2
    Email author
  1. 1.Unit of Arthroscopy and Sports Trauma SurgeryHesperia HospitalModenaItaly
  2. 2.Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and DentistryMile End HospitalLondonUK

Personalised recommendations