Saturday, July 25, 2015

Arthroscopic patch autograft procedure for large to massive rotator cuff tears - are we asking the right question?

Effect of Fatty degeneration of the infraspinatus on the efficacy of arthroscopic patch autograft procedure for large to massive rotator cuff tears.

These authors investigated the results of an arthroscopic fascia lata autograft patch procedure in 45 patients with large to massive rotator cuff tears with high-grade fatty degeneration of the supraspinatus and either low-grade (group L; n=26) or high-grade (group H; n=19) fatty degeneration of the infraspinatus.

Patients in group L had a lower rate of failed repairs (27%) than did those in group H (89%)  as assessed by MRI. The clinical outcome scores and muscle strength ratios were significantly higher in group L than in group H. 

Comment: It is not surprising that patients with more severe cuff disease (high-grade fatty degeneration of both the supraspinatus and the infraspinatus) did more poorly than those with less severe disease (high-grade fatty degeneration of the supraspinatus and low grade fatty degeneration of the infraspinatus). The rate of failure of the repair attempt was high in both groups - even in the 'low grade' group, more than one out of four repairs failed.

The question we should be asking is "what is the value of the arthroscopic patch"? In other words is the improvement in the anatomic and clinical outcomes with this repair technique sufficient to offset the incremental cost and risk of this procedure in comparison to simpler strategies

Should we be trying to repair the irreparable?


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