The Greenhouse technique provides lower re-tear rate and similar outcomes in rotator cuff repair: a prospective randomized controlled trail

J Shoulder Elbow Surg. 2025 Jul 11:S1058-2746(25)00499-9. doi: 10.1016/j.jse.2025.05.030. Online ahead of print.

Abstract

Background: It is still an important issue to reduce the rate of retear after arthroscopic rotator cuff repair (ARCR). a new ARCR technique named "Greenhouse technique" combined with microfracture was proposed to enhance the rotator cuff healing. The purpose of this study was to compare the clinical outcomes and retear rate of Greenhouse technique (GH) with traditional single row repair (SR) in full-thickness rotator cuff tear (FT-RCT) patients in the early term follow-up. We hypothesized that the Greenhouse technique would provide lower retear rate and similar clinical outcomes in ARCR.

Methods: From December, 2020 to March, 2021, 114 FT-RCT patients who received ARCR were randomized into 2 groups, Greenhouse group (56 patients) vs. SR group (58 patients). Functional outcomes including ASES, Constant-Murley, UCLA, SST, VAS for pain, range of motion (ROM) including forward elevation (FE), external rotation (ER) and internal rotation (IR) were evaluated preoperatively, 24 months postoperatively and compared between two groups. Tendon integrity was evaluated by MRI preoperatively and 2 years postoperatively. Bone tunnel healing was evaluated by CT at 3, 6 months postoperatively. Sugaya classification was used to evaluate tendon retear and compared between two groups. The percentage of patients reaching the minimal clinically important difference (MCID), patient acceptable symptoms state (PASS), substantial clinical benefit (SCB) based on ASES were also compared between two groups.

Results: All functional outcomes and ROM improved significantly compared with preoperative index in both groups (all P <.001) at 24 months follow-up. However, there were no significant differences between 2 groups at final follow-up. Overall, 116 patients (85.7%) exceeded the MCID, 114 patients (73.3%) achieved the PASS, and 98 patients (85.0%) achieved SCB without significant differences between the 2 groups. The overall retear rate after ARCR in the GH group was 5.4% and 19.0% in the SR group separately, GH group had significantly lower retear rate than that in SR group(p=0.027). Bone tunnel in 49 patients (90.7%) disappeared in 3 months postoperatively.

Conclusion: Both GH and SR groups achieved significant improvement after ARCR. Comparing with SR group, Greenhouse technique group provided lower retear rate and similar clinical outcomes in the early term follow-up.

Keywords: Shoulder; bone marrow stimulation; repair; rotator cuff.