Daniel Smolen1, Nicolas Haffner2, Rainer Mittermayr3, Florian Hess4, Christoph Sternberg5, Jan Leuzinger5. 1. Etzel Clinic, Pfaeffikon, Switzerland; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. 2. Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria; Orthopedic Hospital Gersthof, Vienna, Austria. 3. Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria; Trauma Center of the Workmen Compensation Board, Vienna, Austria. Electronic address: rainer.mittermayr@trauma.lbg.ac.at. 4. Department of Orthopedic Surgery and Traumatology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland. 5. Etzel Clinic, Pfaeffikon, Switzerland.
Abstract
BACKGROUND: Massive rotator cuff (RC) tears still present a clinically challenging problem, with reported rerupture rates in up to 94%. The study objective was to determine the impact of synthetic patch augmentation for massive RC tears. METHODS: Between June 2012 and 2014, we performed 50 arthroscopic RC reconstructions augmented with a synthetic polyester patch. Pre- and postoperative imaging methods included arthrographic magnetic resonance imaging, arthrographic computed tomography, and ultrasound examination to determine tendon integrity or rerupture. Clinical outcome was evaluated using the Constant-Murley score and the subjective shoulder value. Mean clinical midterm and final follow-up was 22 months (9-35 months) and 52 months (25-74 months), respectively. RESULTS: The mean Constant-Murley score increased significantly from 36.5 (±16.4 standard deviation [SD]) preoperatively to a midterm value of 81.2 (±9.6 SD; P < .0001) and further improved to a mean of 83.4 (±10.8 SD) at final follow-up. The mean subjective shoulder value increased from 40.3 (±24.3 SD) to 89.2 (±12.9 SD; P < .0001) at midterm and to 89.6 (±15.2 SD) at final follow-up. We observed 7 complete reruptures (14%). However, reruptures did not correlate with revision surgery, which was performed in 8 patients. The main reason for revision was frozen shoulder or arthrofibrosis with an intact reconstruction and patch, which was performed in 6 cases. CONCLUSIONS: The retear rate of 14% compared favorably with nonaugmented RC repairs in the literature. Therefore, we conclude that patch augmentation in massive RC tears is feasible to reduce retears and to improve clinical outcome.
BACKGROUND: Massive rotator cuff (RC) tears still present a clinically challenging problem, with reported rerupture rates in up to 94%. The study objective was to determine the impact of synthetic patch augmentation for massive RC tears. METHODS: Between June 2012 and 2014, we performed 50 arthroscopic RC reconstructions augmented with a synthetic polyester patch. Pre- and postoperative imaging methods included arthrographic magnetic resonance imaging, arthrographic computed tomography, and ultrasound examination to determine tendon integrity or rerupture. Clinical outcome was evaluated using the Constant-Murley score and the subjective shoulder value. Mean clinical midterm and final follow-up was 22 months (9-35 months) and 52 months (25-74 months), respectively. RESULTS: The mean Constant-Murley score increased significantly from 36.5 (±16.4 standard deviation [SD]) preoperatively to a midterm value of 81.2 (±9.6 SD; P < .0001) and further improved to a mean of 83.4 (±10.8 SD) at final follow-up. The mean subjective shoulder value increased from 40.3 (±24.3 SD) to 89.2 (±12.9 SD; P < .0001) at midterm and to 89.6 (±15.2 SD) at final follow-up. We observed 7 complete reruptures (14%). However, reruptures did not correlate with revision surgery, which was performed in 8 patients. The main reason for revision was frozen shoulder or arthrofibrosis with an intact reconstruction and patch, which was performed in 6 cases. CONCLUSIONS: The retear rate of 14% compared favorably with nonaugmented RC repairs in the literature. Therefore, we conclude that patch augmentation in massive RC tears is feasible to reduce retears and to improve clinical outcome.
Authors: Mathew Baldwin; N S Nagra; Gemma Greenall; Andrew J Carr; David Beard; J L Rees; Amar Rangan; Naomi Merritt; Melina Dritsaki; Sally Hopewell; Jonathan Alistair Cook Journal: BMJ Open Date: 2020-12-07 Impact factor: 2.692
Authors: André Luís Lugnani de Andrade; Thiago Alves Garcia; Henrique de Sancti Brandão; Amanda Veiga Sardeli; Guilherme Grisi Mouraria; William Dias Belangero Journal: Orthop J Sports Med Date: 2022-03-24