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Current Reviews in Musculoskeletal Medicine

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01-10-2020 | Painful Arc | Surgical Management of Massive Irreparable Cuff Tears (J Sanchez-Sotelo, Section Editor)

Patch Augmentation in Rotator Cuff Repair

Authors: Peter N. Chalmers, Robert Z. Tashjian

Published in: Current Reviews in Musculoskeletal Medicine | Issue 5/2020

Abstract

Purpose of the Review

Rotator cuff repair has excellent outcomes for many patients but continues to be suboptimal for large, retracted tears, and revision procedures. In these situations, patch augmentation may be considered in order to improve healing. The purpose of this article is to review the history, graft options, indications, surgical technique, outcomes, and complications associated with arthroscopic patch augmentation for rotator cuff repair.

Recent Findings

Patch augmentation has been shown in several studies to improve healing rates. After multiple investigations into different materials available for patch augmentation, acellular dermal allograft seems to be the graft with the best scientific support. While multiple techniques have been presented, few studies have compared their performance.

Summary

While the arthroscopic technique for patch augmentation can be challenging, we present a systematic approach to this procedure with the potential to reliably and predictably perform patch augmentation. This technique is a valuable tool for surgeons that treat rotator cuff pathology.

Abdel MP, Salib CG, Mara KC, Pagnano MW, Perry KI, Hanssen AD. Extensor mechanism reconstruction with use of Marlex mesh. J Bone Jt Surg. 2018;100(15):1309–18. https://doi.org/10.2106/jbjs.17.01165.CrossRef

Audenaert E, Nuffel VJ, Schepens A, Verhelst M, Verdonk R. Reconstruction of massive rotator cuff lesions with a synthetic interposition graft: a prospective study of 41 patients. Knee Surg Sports Traumatology Arthrosc. 2006;14(4):360–4. https://doi.org/10.1007/s00167-005-0689-7.CrossRef

Badhe SP, Lawrence TM, Smith FD, Lunn PG. An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elb Surg. 2008;17(1):S35–9. https://doi.org/10.1016/j.jse.2007.08.005.CrossRef

Barber AF, Burns JP, Deutsch A, Labbé MR, Litchfield RB. A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthrosc J Arthrosc Relat Surg. 2012;28(1):8–15. https://doi.org/10.1016/j.arthro.2011.06.038.CrossRef

•• Cai Y-Z, Zhang C, Jin R-L, Shen T, Gu P-C, Lin X-J, et al. Arthroscopic rotator cuff repair with graft augmentation of 3-dimensional biological collagen for moderate to large tears: a randomized controlled study. Am J Sports Medicine. 2018;46(6):1424–31. https://doi.org/10.1177/0363546518756978This randomized study demonstrated that patch augmentation can significantly decrease retear rates and improve outcomes.CrossRef

Chalmers PN, Frank RM, Gupta AK, Yanke AB, Trenhaile SW, Romeo AA, et al. All-arthroscopic patch augmentation of a massive rotator cuff tear: surgical technique. Arthrosc Techniques. 2013;2(4):e447–51. https://doi.org/10.1016/j.eats.2013.07.003.CrossRef

Chalmers PN, Granger E, Nelson R, Yoo M, Tashjian RZ. Factors affecting cost, outcomes, and tendon healing after arthroscopic rotator cuff repair. Arthrosc J Arthrosc Relat Surg. 2018;34:1393–400. https://doi.org/10.1016/j.arthro.2017.11.015.CrossRef

• Chalmers PN, Ross H, Granger E, Presson AP, Zhang C, Tashjian RZ. The effect of rotator cuff repair on natural history. Jbjs Open Access. 2018;3(1):e0043. https://doi.org/10.2106/jbjs.oa.17.00043This meta-analysis demonstrates that rotator cuff repair decreases tear size as compared to non-operative treatment and may thus interrupt the natural history of rotator cuff disease.CrossRefPubMedPubMedCentral

Chalmers PN, Salazar DH, Steger-May K, Chamberlain AM, Stobbs-Cucchi G, Yamaguchi K, et al. Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears. J Shoulder Elb Surg. 2016;25(11):1749–55. https://doi.org/10.1016/j.jse.2016.07.022.CrossRef

10.

Ciampi P, Scotti C, Nonis A, Vitali M, Serio C, Peretti GM, et al. The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears. Am J Sports Medicine. 2014;42(5):1169–75. https://doi.org/10.1177/0363546514525592.CrossRef

11.

•• Collin P, Kempf J-F, Accent D, Meyer N, Agout C, Saffarini M, et al. Ten-year multicenter clinical and MRI evaluation of isolated supraspinatus repairs. J Bone Jt Surg. 2017;99(16):1355–64. https://doi.org/10.2106/jbjs.16.01267This important long-term study demonstrates that rotator cuff repairs that heal in the short term remain healed in the long-term.CrossRef

12.

Consigliere P, Polyzois I, Sarkhel T, Gupta R, Levy O, Narvani AA. Preliminary results of a consecutive series of large & massive rotator cuff tears treated with arthroscopic rotator cuff repairs augmented with extracellular matrix. Archives Bone Jt Surg. 2017;5(1):14–21. https://doi.org/10.22038/abjs.2016.7932.CrossRef

13.

Derwin KA, Badylak SF, Steinmann SP, Iannotti JP. Extracellular matrix scaffold devices for rotator cuff repair. J Shoulder Elb Surg. 2010;19(3):467–76. https://doi.org/10.1016/j.jse.2009.10.020.CrossRef

14.

•• Diebold G, Lam P, Walton J, Murrell GA. Relationship between age and rotator cuff retear: a study of 1,600 consecutive rotator cuff repairs. J Bone Jt Surg. 2017;99(14):1198–205. https://doi.org/10.2106/jbjs.16.00770This important study demonstrates the negative impacts of age and tear size upon healing with rotator cuff repair, and thus the role for patch augmentation in these settings.CrossRef

15.

Ferguson DP, Lewington MR, Smith DT, Wong IH. Graft utilization in the augmentation of large-to-massive rotator cuff repairs. Am J Sports Medicine. 2016;44(11):2984–92. https://doi.org/10.1177/0363546515624463.CrossRef

16.

• Flury M, Rickenbacher D, Jung C, Schneider MM, Endell D, Audigé L. Porcine dermis patch augmentation of supraspinatus tendon repairs: a pilot study assessing tendon integrity and shoulder function 2 years after arthroscopic repair in patients aged 60 years or older. Arthrosc J Arthrosc Relat Surg. 2018;34(1):24–37. https://doi.org/10.1016/j.arthro.2017.06.024 This study further demonstrates that xenograft patches are problematic.CrossRef

17.

Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. The Journal of Bone and Joint Surgery. 2004;86-A(2):219–24.CrossRef

18.

Gupta AK, Hug K, Berkoff DJ, Boggess BR, Gavigan M, Malley PC, et al. Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Medicine. 2012;40(1):141–7. https://doi.org/10.1177/0363546511422795.CrossRef

19.

Gupta AK, Hug K, Boggess B, Gavigan M, Toth AP. Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis. Am J Sports Medicine. 2013;41(4):872–9. https://doi.org/10.1177/0363546512475204.CrossRef

20.

Hartzler RU, Melapi S, de Beer JF, Burkhart SS. Arthroscopic joint preservation in severe glenohumeral arthritis using interpositional human dermal allograft. Arthrosc J Arthrosc Relat Surg. 2017;33(11):1920–5. https://doi.org/10.1016/j.arthro.2017.04.005.CrossRef

21.

• Hebert-Davies J, Teefey SA, Steger-May K, Chamberlain AM, Middleton W, Robinson K, et al. Progression of fatty muscle degeneration in atraumatic rotator cuff tears. J Bone Jt Surg. 2017;99(10):832–9. https://doi.org/10.2106/jbjs.16.00030 This study demonstrates that fatty infiltration is progressive with time.CrossRef

22.

Hohn EA, Gillette BP, Burns JP. Outcomes of arthroscopic revision rotator cuff repair with acellular human dermal matrix allograft augmentation. J Shoulder Elb Surg. 2018;27(5). https://doi.org/10.1016/j.jse.2017.09.026.

23.

Keener JD, Galatz LM, Stobbs-Cucchi G, Patton R, Yamaguchi K. Rehabilitation following arthroscopic rotator cuff repair. J Bone Jt Surg. 2014;96(1):11–9. https://doi.org/10.2106/jbjs.m.00034.CrossRef

24.

Keener JD, Galatz LM, Teefey SA, Middleton WD, Steger-May K, Stobbs-Cucchi G, et al. A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Jt Surg. 2015;97(2):89–98. https://doi.org/10.2106/jbjs.n.00099.CrossRef

25.

•• Kim J, Lee J-H, Kim K-S, Ji J-H, Koh S-J, Lee J-H. Rotator cuff bridging repair using acellular dermal matrix in large to massive rotator cuff tears: histologic and clinical analysis. J Shoulder Elb Surg. 2017;26(11). https://doi.org/10.1016/j.jse.2017.04.010This histology study shows that acellular dermal allograft patches can incorporate.

26.

Lederman ES, Toth AP, Nicholson GP, Nowinski RJ, Bal GK, Williams GR, et al. A prospective, multicenter study to evaluate clinical and radiographic outcomes in primary rotator cuff repair reinforced with a xenograft dermal matrix. J Shoulder Elb Surg. 2016;25(12):1961–70. https://doi.org/10.1016/j.jse.2016.02.029.CrossRef

27.

Lee NM, Erisken C, Iskratsch T, Sheetz M, Levine WN, Lu HH. Polymer fiber-based models of connective tissue repair and healing. Biomaterials. 2017;112:303–12. https://doi.org/10.1016/j.biomaterials.2016.10.013.CrossRefPubMed

28.

•• Lewington MR, Ferguson DP, Smith DT, Burks R, Coady C, Wong I. Graft utilization in the bridging reconstruction of irreparable rotator cuff tears: a systematic review. Am J Sports Medicine. 2017;45(13):3149–57. https://doi.org/10.1177/0363546517694355This systematic review shows that patch ainterposition improves outcomes.CrossRef

29.

Linderman SW, Golman M, Gardner TR, Birman V, Levine WN, Genin GM, et al. Enhanced tendon-to-bone repair through adhesive films. Acta Biomater. 2018. https://doi.org/10.1016/j.actbio.2018.01.032.

30.

Mascarenhas R, Chalmers PN, Sayegh ET, Bhandari M, Verma NN, Cole BJ, et al. Is double-row rotator cuff repair clinically superior to single-row rotator cuff repair: a systematic review of overlapping meta-analyses. Arthrosc J Arthrosc Relat Surg. 2014;30(9):1156–65. https://doi.org/10.1016/j.arthro.2014.03.015.CrossRef

31.

McElvany MD, McGoldrick E, Gee AO, Neradilek M, Matsen FA. Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Medicine. 2014;43(2). https://doi.org/10.1177/0363546514529644.

32.

Mihata T, Lee TQ, Fukunishi K, Itami Y, Fujisawa Y, Kawakami T, et al. Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears. Am J Sports Medicine. 2018;46(5):1077–83. https://doi.org/10.1177/0363546517753387.CrossRef

33.

Mihata T, Lee TQ, Hasegawa A, Kawakami T, Fukunishi K, Fujisawa Y, et al. Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears. Am J Sports Medicine. 2018;46(11):2707–16. https://doi.org/10.1177/0363546518786489.CrossRef

34.

Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthrosc J Arthrosc Relat Surg. 2013;29(3):459–70. https://doi.org/10.1016/j.arthro.2012.10.022.CrossRef

35.

•• Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, et al. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. J Bone Jt Surg Am. 2019;101(12):1050–60. https://doi.org/10.2106/jbjs.18.01373This randomized clinical trial demonstrates the value of rotator cuff repair over non-operative treatment.CrossRef

36.

Mori D, Funakoshi N, Yamashita F. Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade fatty degeneration of the Infraspinatus: patch autograft procedure versus partial repair procedure. Arthrosc J Arthrosc Relat Surg. 2013;29(12):1911–21. https://doi.org/10.1016/j.arthro.2013.08.032.CrossRef

37.

Neumann JA, Zgonis MH, Rickert KD, Bradley KE, Kremen TJ, Boggess BR, et al. Interposition dermal matrix xenografts: a successful alternative to traditional treatment of massive rotator cuff tears. Am J Sports Medicine. 2017;45(6):1261–8. https://doi.org/10.1177/0363546516683945.CrossRef

38.

Ranebo MC, Hallgren HC, Norlin R, Adolfsson LE. Long-term clinical and radiographic outcome of rotator cuff repair with a synthetic interposition graft: a consecutive case series with 17 to 20 years of follow-up. J Shoulder Elb Surg. 2018;27(9). https://doi.org/10.1016/j.jse.2018.03.011.

39.

Scheibel M, Brown A, Woertler K, Imhoff AB. Preliminary results after rotator cuff reconstruction augmented with an autologous periosteal flap. Knee Surg Sports Traumatology Arthrosc. 2007;15(3):305–14. https://doi.org/10.1007/s00167-006-0173-z.CrossRef

40.

Shepherd HM, Lam PH, Murrell GA. Synthetic patch rotator cuff repair: a 10-year follow-up. Shoulder Elb. 2013;6(1):35–9. https://doi.org/10.1111/sae.12046.CrossRef

41.

Soler AJ, Gidwani S, Curtis MJ. 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. Acta Orthop Belg. 2007;73(4):432–6.PubMed

Title: Patch Augmentation in Rotator Cuff Repair
Authors: Peter N. Chalmers
Robert Z. Tashjian
Publication date: 01-10-2020
Publisher: Springer US
Keyword: Painful Arc
Published in: Current Reviews in Musculoskeletal Medicine / Issue 5/2020
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09658-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Patch Augmentation in Rotator Cuff Repair

Abstract

Purpose of the Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of the Review

Recent Findings

Summary

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