Early complications from the use of porcine dermal collagen implants (Permacol) as bridging constructs in the repair of massive rotator cuff tears. A report of 4 cases.

The repair of massive rotator cuff tears can be very challenging. Different surgical techniques are described in the literature, including debridement of the cuff with subacromial decompression, attempts at direct partial repair, various tendon transfers, shoulder hemiarthroplasty, reversed shoulder arthroplasty and allograft augmentation. Following favourable published evidence of the use of porcine dermal collagen implants, Permacol (Tissue Science Laboratories, Hampshire, UK, now known as Collagen Repair Patch, Zimmer, Warsaw, Ind) as a bridging device to repair massive defects, we used it in four of our patients. However, we have seen with great concern that in all four cases, the grafts failed between 3-6 months after a promising early postoperative period. We report on these 4 cases giving clinical, radiographic and histological findings. We conclude that although Permacol has man obvious advantages, it should not be used to bridge irreparable massive rotator cuff tears.