No Benefit to Intraoperative Channeling in Rotator Cuff Repair?

Adding intraoperative channeling to arthroscopic rotator cuff repair doesn’t improve healing rates, according to new multi-center, randomized controlled trial (RCT) study.

According to lead investigator, Dr. Peter Lapner, M.D., FRCSC of The Ottawa Hospital, University of Ottawa, “Bone channeling is an adjuvant procedure used in arthroscopic cuff repair. It involves creating small perforations in the bone at the tendon insertion site prior to rotator cuff repair.”

“It is known by various names, including ‘microfracture’, ‘crimson duvet’ and ‘nanofracture’. The hypothesis was that these bone perforations would enhance the healing rate of tendon repair by recruiting mesenchymal stem cells (MSCs)—the cells that orchestrate tendon healing.”

The study, “Intraoperative Channeling in Arthroscopic Rotator Cuff Repair: A Multicenter Randomized Controlled Trial,” was published online on December 1, 2022, in The American Journal of Sports Medicine.

Lapner and colleagues hypothesized that bone channeling during arthroscopic rotator cuff repair would lead to a higher healing rate compared with standard rotator cuff repair.

The primary outcome of their analysis was a comparison of healing rates in patients undergoing arthroscopic rotator cuff repair with and without bone channeling. The researchers also employed Western Ontario Rotator Cuff Index scores, American Shoulder and Elbow Surgeon scores, Constant scores, Constant strength sub-scores and Visual Analog Scale for pain scores to quantify the results of their study.

Dr. Lapner and his team enrolled patients at three different clinical sites between 2013 and 2018 and then randomized the patients to receive either standard rotator cuff repair or repair with bone channeling. The team used ultrasound imaging at 24 months postop and patient-reported outcomes at baseline and at 3, 6, 12 and 24 months postoperatively to build the study dataset.

After analyzing data from 168 patients, the team found no significant difference in healing rates between the two groups at 24 months after surgery. And both groups showed significant improvements in the patient-reported outcome scores with no major differences between the two groups at any time point.

The researchers also reported no superiority of intraoperative bone channeling in rotator cuff repair over standard rotator cuff repair at 24 months postoperatively. Healing rates, patient-reported function, and quality-of-life outcomes were all similar between groups.

Lapner explained further:

“At the time the study was initiated, few studies were published on this topic, and our theory was that channeling would improve healing rates in arthroscopic cuff repair. Trials by Milano et al., Osti et al., and Toro et al. did not find any additional benefit to channeling compared with a standard cuff repair. However, a recent study by Ruiz Iban et al. reported a significantly lower re-tear rate of 19.4% in the ‘nanofracture’ group versus 42.4% in the control group. Our findings are in keeping with Milano et al., Osti et al., and Toro et al. in that no benefit was observed in healing rates or functional outcome scores with adjuvant channeling of the rotator cuff footprint. In fact, we found a statistical trend toward higher healing rates in the control group compared to the channeling group.”

Study authors include Peter Lapner, M.D., FRCSC, J.W.Pollock, M.D., FRCSC, Stephanie Coupal, M.D., FRCSC, Elham Sabri, MSc, Taryn Hodgon, Kate Mcilquham, MSc, of The Ottawa Hospital, University of Ottawa in Canada and CSES Investigators: Greg Stranges, M.D.,FRCSC, of University of Manitoba in Canada, Randa Berdusco, M.D., FRCSC of The Ottawa Hospital, University of Ottawa, and Jonathan Marsh, M.D., FRCSC, James Dubberley, M.D.,FRCSC and Sheila McRae, Ph.D., also from the University of Manitoba.

Martin Bouliane, M.D., FRCSC, of Glen Sather Sports Medicine Clinic at University of Alberta in Canada, and Jason Old and Peter MacDonald, M.D., FRCSC of University of Manitoba in Canada also contributed to the study.