Monday, May 2, 2016

Rotator cuff repair reinforcement with extracellular matrix graft - does integrity matter?

A prospective, multicenter study to evaluate clinical and radiographic outcomes in primary rotator cuff repair reinforced with a xenograft dermal matrix.

These authors studied  61 shoulders with large repairable rotator cuff tears (3 to 5 cm). The rotator cuff tears were surgically repaired and reinforced with a extracellular matrix (ECM) xenograft. The average patient age was 56 years (range, 40-69 years). The average tear size was 3.8 cm.  Double row cuff repair was performed by minimally invasive open technique.  The graft was cut to overlap the completed repair of the rotator cuff covering the entire repair and was attached medially using a modified Mason-Allen technique.

Functional outcome scores, isometric muscle strength, and active range of motion were significantly improved compared with baseline. 
Magnetic resonance imaging at 12 months showed retorn rotator cuff repairs in 33.9% of shoulders, using the criteria of a tear of at least 1 cm, and tears in 14.5% of the shoulders using the criteria of retear >80% of the original tear size. Three patients underwent surgical revision. Complications included 1 deep infection.

Comment: While the absence of a comparison group treated without ECM does not allow determination of the value (benefit/cost) of the ECM in comparison to double row repairs performed without graft, the results are interesting in two particular regards. First the retear rates did not increase between 6 and 12 months. 

Second, the clinical outcomes showed the same amount of improvement whether or not the cuff repairs remained intact or retore as shown below.


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