Purpose
This study aimed to compare the arthroscopic patch graft procedure and partial repair
for irreparable large or massive rotator cuff tears (RCTs) in shoulders with low-grade
fatty degeneration of the infraspinatus (stage 1 or 2 according to Goutallier et al.)
in terms of the functional and structural outcomes.
Methods
This study included 24 patients who underwent the patch graft procedure (group A)
and 24 patients who underwent partial repair (group B) for irreparable large or massive
RCTs. Clinical outcomes were evaluated at a mean of 35.5 months postoperatively in
group A and 35.7 months in group B.
Results
The clinical findings were significantly improved at the final follow-up in both groups
(P < .001). A significant difference was found between groups A and B in terms of postoperative
Constant and American Shoulder and Elbow Surgeons scores (P = .001 and P = .021, respectively). There was a significant difference in the retear rate for
the infraspinatus tendon (ISP) between the 2 groups (2 patients [8.3%] in group A
v 10 patients [41.7%] in group B, P = .015). At the final follow-up, there was a significant difference in the affected
side–versus–unaffected side muscle strength ratios for abduction and external rotation
between group A and group B (P < .001 for both). Shoulders with retears of the ISP showed significantly inferior
clinical outcomes compared with those without retears (P < .001).
Conclusions
In arthroscopic surgery for irreparable large or massive RCTs with low-grade fatty
degeneration of the infraspinatus, the patch graft procedure showed an 8.3% retear
rate for the repaired ISP with both improved clinical scores and recovery of muscle
strength, whereas the partial repair had a retear rate of 41.7% (P = .015).
Level of Evidence
Level Ш, retrospective comparative study.
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References
- Arthroscopic treatment of massive rotator cuff tears: Clinical results and biomechanical rationale.Clin Orthop Relat Res. 1991; 267: 45-56
- Massive rotator cuff tears: Debridement versus repair.Orthop Clin North Am. 1997; 28: 117-124
- Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: A study in thirteen patients.J Shoulder Elbow Surg. 2007; 16: 691-696
- Fatty muscle degeneration cuff ruptures. Pre- and postoperative evaluation by CT scan.Clin Orthop Relat Res. 1994; 304: 78-83
- Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears.J Shoulder Elbow Surg. 2003; 12: 550-554
- Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study.J Bone Joint Surg Am. 2007; 89: 953-960
- Massive rotator cuff tears: Functional outcome after debridement or arthroscopic partial repair.J Orthop Traumatol. 2010; 11: 13-20
- Massive rotator cuff tears: The result of partial rotator cuff repair.J Shoulder Elbow Surg. 2005; 14: 121-127
- Arthroscopic debridement of massive irreparable rotator cuff tears.Arthroscopy. 2008; 24: 743-748
- Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears.J Bone Joint Surg Am. 2006; 88: 113-120
- Biomechanical and biologic augmentation for the treatment of massive rotator cuff tears.Am J Sports Med. 2010; 38: 619-629
- A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair.Arthroscopy. 2012; 28: 8-15
- Surgical treatment for large and massive tears of the rotator cuff.Int Orthop. 2003; 27: 228-231
- Massive tears of the rotator cuff.J Bone Joint Surg Am. 2010; 92: 1894-1908
- Fatty infiltration of disrupted rotator cuff muscles.Rev Rhum Engl Ed. 1995; 62: 415-422
- Partial repair of irreparable rotator cuff tears.Arthroscopy. 1994; 10: 367-370
- Surgical repair of chronic rotator cuff tears. A prospective long-term study.J Bone Joint Surg Am. 2001; 83: 71-77
- Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation.Arthroscopy. 2008; 24: 983-991
- entrapment of the suprascapular nerve.J Bone Joint Surg Br. 1999; 81: 414-419
- MR imaging of the shoulder after rotator cuff repair.AJR Am J Roengenol. 1997; 168: 559-563
- Shoulder after surgery: MR imaging with surgical validation.Radiology. 1993; 186: 443-447
- Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff.J Bone Joint Surg Am. 2008; 90: 962-969
- Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. Surgical Technique.J Bone Joint Surg Am. 2009; 91: 1-7
- Partial repair of irreparable supraspinatus tendon tears: Clinical and radiographic evaluations at long-term follow-up.J Shoulder Elbow Surg. 2011; 20: 1170-1177
- Scoring systems for the functional assessment of the shoulder.Arthroscopy. 2003; 19: 1109-1120
- Arthroscopic repair of full-thickness tears of the supraspinatus: Does the tendon really heal?.J Bone Joint Surg Am. 2005; 87: 1229-1240
- Clinical outcome after structural failure of rotator cuff repairs.J Bone Joint Surg Am. 2000; 82: 304-314
- Rotator cuff integrity after arthroscopic repair for large tears with less-than-optimal footprint coverage.Arthroscopy. 2009; 25: 1093-1100
- Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs.Am J Sports Med. 2004; 32: 1716-1722
- Functional and magnetic resonance imaging evaluation after single-tendon rotator reconstruction.J Shoulder Elbow Surg. 1999; 8: 242-246
- Clinical and radiographic outcomes after arthroscopic repair of massive rotator cuff tears using a suture bridge technique: Assessment of repair integrity on magnetic resonance imaging.Am J Sports Med. 2012; 40: 786-793
- Functional and structural outcomes of single-row versus double-row versus combined double-row and suture-bridge repair for rotator cuff tears.Am J Sports Med. 2011; 39: 2091-2098
- Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation.Arthroscopy. 2005; 21: 1307-1316
- Arthroscopic replacement of massive irreparable rotator cuff tears using a GraftJacket allograft: Technique and preliminary results.Arthroscopy. 2008; 24 (Available online at): 403-409.e1
- Dermal tissue allograft for the repair of massive irreparable rotator cuff tears.Am J Sports Med. 2012; 40: 141-147
- Commercial extracellular matrix scaffolds for rotator cuff tendon repair. Biomechanical, biochemical, and cellular properties.J Bone Joint Surg Am. 2006; 88: 2665-2672
- Regional variability, processing methods, and biophysical properties of human fascia lata extracellular matrix.J Biomed Mater Res A. 2008; 84: 500-507
- Experimental fascial autografting for the supraspinatus tendon defect: Remodeling process of the grafted fascia and the insertion into bone.J Shoulder Elbow Surg. 2002; 11: 166-173
Article info
Publication history
Published online: October 28, 2013
Accepted:
August 26,
2013
Received:
February 7,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
