Wednesday, December 17, 2014

Cuff repairs and patch reinforcement

Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device.

This author reports a small series of 18 patients with repairs of large to massive rotator cuff tears reinforced with a poly-l-lactic acid synthetic patch.

The ultrasound examination targeted the supraspinatus, infraspinatus, and subscapularis to detect the presence of the tendons and their attachment to the bone. The shoulder was observed while the patient moved the arm to determine attachment and functionality of the graft. This examination showed that 15 of 18 patients had intact rotator cuff repair at 12 months; at 42 months, an additional patient had a failed repair. 

Overall, patients showed improvement in the ASES shoulder score from 25 preoperatively to 70 at 42 months after surgery. Patients with intact rotator cuff (n = 14) at 42 months had an ASES shoulder score of 82.

Comment: While these results seem encouraging, the experience of the sonographer and the ability of the technique to determine the integrity of a repair after grafting is not stated. 

At this time the reported results with patch reinforcement are not universally favorable as shown here, and here, and here. At present we have not found the evidence supporting the use of patches in cuff repair to be compelling.


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