Biological Augmentation with subacromial bursa in arthroscopic rotator cuff repair: clinical outcomes and tendon assessment using Doppler ultrasonography

Background The subacromial bursa is a key source of mesenchymal stem cells that may support rotator cuff tendon healing. Since microvascularization contributes to tendon repair, we aimed to examine postoperative morphology—especially vascularity—after bursa augmentation during arthroscopic rotator cuff repair. Methods: In this prospective comparative study (2019–2023), we included patients with crescent-shaped posterosuperior rotator cuff tears (SSP ± ISP, SCP Tear Lafosse ≤ 1), tendon retraction ≤ 2 according to Patte, and fatty infiltration ≤ 2 according to Goutallier. All underwent double-row arthroscopic repair, either with bursa augmentation (Group B) or without (control, Group C). The primary outcome was postoperative Doppler signal assessment of neovascularization and tendon integrity via ultrasound at 3, 6, 12, and 24 weeks. Secondary outcomes included pain scores (rest and activity) and functional results. Results: Thirty patients were analyzed: 20 in Group B and 10 in Group C, mean age 60. All patients completed the 6-month follow-up. Group B showed an initial increase in bursal neovascularization at 3 weeks, which declined thereafter in both groups. At 6 weeks, Group B showed a trend toward higher neovascularization at the tendon insertion, while Group C showed a significant reduction (p = 0.032). Pain levels were consistently lower in Group B, with significant differences at 6 weeks (rest, p = 0.013) and 3 months (activity, p = 0.009). Tendon thickness was better preserved in Group B, with significant differences at 3 (p = 0.029) and 6 months (p = 0.007). No significant group differences in postoperative funtion were noted after 6 months. At 6 months, two patients in Group B had partial SSP ruptures; one also had a complete ISP rupture requiring revision. No retears occurred in the control group. Conclusion: Clinical outcomes were similar between bursa-augmented rotator cuff repair and the control group. While bursa augmentation did not enhance neovascularization compared to controls, it was associated with better tendon thickness preservation and reduced pain. No complete retears were observed in the bursa group, suggesting a potential protective effect. TRIAL Registration NCT03986749, 11.06.2019