Wednesday, March 9, 2016

Irreparable cuff tears - is an iliotibial-bone autograft useful?

Rotator cuff repair using an original iliotibial ligament with a bone block patch: preliminary results with a 24-month follow-up period.

These authors advocate managing massive shoulder rotator cuff tears not amenable to primary repair with a patching method that uses an autograft consisting of a section of the iliotibial band with an attached bone block so that the ligament part of the graft is sutured to the remaining rotator cuff and the bone end fixed to the greater tuberosity using a suture bridge. They state that this operative procedure is applicable when primary repair is not possible but repair of the subscapularis and infraspinatus muscles alone is possible

They report 5 patients with 2 years followup.

Patients were clinically improved. No mention is made of complications or the time necessary to perform the procedure.  Fusion of the bone graft with the greater tubercle of the humerus was confirmed on computed tomography in all patients. No retearing was observed on magnetic resonance imaging at the 24-month point, and the thickness of the ligament part of the graft was maintained.

Comment: This is clearly a big procedure, requiring surgery on the shoulder and the knee.

Below is a preoperative MRI

And here is a postoperative MRI at two years. While tissue apparently remains between the humeral head and the acromion, the muscle seems to have remained atrophic and the connection between the graft and the muscle appears slack.

it will be important to compare the results of this procedure with a more conservative surgical procedure in which no attempt is made to span the defect in the rotator cuff, the smooth and move. See this link 


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