Monday, December 15, 2014

What is the value of patch augmentation in the treatment of massive rotator cuff tears?

Treatment of massive and recurrent rotator cuff tears augmented with a poly-l-lactide graft, a preliminary study.

These authors report a retrospective study of 16 patients with massive or recurrent rotator cuff tears who underwent open repair with synthetic poly-l-lactide patch augmentation. Three patients were excluded: two required the patch to bridge defects, and one retore after a motor vehicle accident and had revision surgery at another institution.

The followup for the 13 remaining patients was 1.2 to 1.7 years (average, 1.5 years). Magnetic resonance imaging was used to examine the integrity of the repair at a minimum of 1 year of follow-up.

Five patients (38%) had an intact rotator cuff at the time of follow-up. The remaining patients (62%) had full-thickness retears. The PENN and American Shoulder and Elbow Surgeons scores significantly improved. Data were not provided on the results in those with retears in comparison to those with intact repairs. 

Comment: From the data presented it is difficult to determine the value of the graft, that is the improvement in the outcome divided by the cost of the device and the additional time to implant it. The role of the graft in determining the result for these patients is unknown.


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