Purpose
To evaluate the clinical outcomes of patients who underwent biologically enhanced
patch augmentation repair for the treatment of revision massive rotator cuff tears.
Methods
Twenty-two patients who underwent arthroscopic and mini-open rotator cuff repair using
a patch augmented with platelet-rich plasma and concentrated bone marrow aspirate
(cBMA) for revision massive (≥2 tendons) rotator cuff tears from 2009 to 2014, with
a minimum 1-year follow-up, were included in the study. In this procedure the medial
side of the graft is secured to the rotator cuff tendon remaining medially. American
Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test, and postoperative Single
Assessment Numerical Evaluation scores were evaluated. To determine the clinical relevance
of ASES scores, the minimal clinically important difference, substantial clinical
benefit (SCB), and the patient-acceptable symptomatic state (PASS) thresholds were
used. Clinical success or failure was defined based on whether the patient reached
the SCB threshold. In the laboratory, cellular counting along with the concentration
of connective tissue progenitor cells were performed on patch samples from the day
of surgery. Scaffolds were processed histologically at days 0, 7,14, and 21 of culture.
Results
Patients had significant improvement in the Simple Shoulder Test (2.6 ± 3.0pre vs 5.2 ± 4.2post, P = .01), whereas improvement in pain scores was found to be nonsignificant (5.6 ±
2.5pre vs 4.2 ± 3.4post, P = .11) at final follow-up. Mean ASES improved by Δ14.6 ± 33.4 points; however, this
did not reach statistical significance (40.2 ± 21.6pre vs 53.9 ± 31.4post, P = .10). With regards to ASES score, 45% of patients achieved the minimal clinically
important difference, 41% the SCB, and 32% reached or exceeded the PASS criteria.
At 21 days, there was a significantly greater cell count in scaffolds from patients
who had clinical success than those who were failures (P = .02).
Conclusions
Only 41% of patients undergoing biologically enhanced patch augmentation repair reached
substantial clinical benefit, whereas 32% reached or exceeded the PASS criteria.
Level of Evidence
Case Series: Level IV.
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Article info
Publication history
Published online: March 30, 2020
Accepted:
February 1,
2020
Received:
July 24,
2019
Footnotes
See commentary on page 1552
The authors report the following potential conflict of interest or source of funding: A.D.M. receives consulting fees as well as research support from Arthrex. The company had no involvement in the study design, data collection, or final manuscript. R.A.A. receives research support from Arthrex. In addition, R.A.A. is a consultant for Biorez. M.P.C. receives personal fees from the Arthroscopy Association of North America (AANA) for the Arthroscopy Journal. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
This study was performed at the Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Biologically-Enhanced Patch Augmentation: The Perfect Marriage of Mechanical Stability and Biology for Rotator Cuff Healing? Unfortunately, Not YetArthroscopyVol. 36Issue 6
- PreviewRecurrent rotator cuff tears are a frequent cause of shoulder disability. To repair a rotator cuff, the surgeon faces both mechanical and biological challenges. Patch use as a scaffold for rotator cuff repair is well-described, as is biological augmentation, with clinical indications and efficacy being the subjects of ongoing study. However, a clinical report of dermal allograft patch augmentation combined with attempts at supercharging the biology is novel. This technique would benefit from controlled, prospective studies, with tight inclusion criteria.
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