Monday, September 19, 2016

Over 50% of rotator cuff repairs failed, with or without a biological graft

These authors randomized 62 patients with moderate and large cuff tears to repair alone (control) or augmentation with SIS (Restore Orthobiologic Implant; DePuy, Warsaw, IN, USA). Primary outcome was repair failure using magnetic resonance orthography. The average tear measured 3 cm in the anteroposterior direction and 2.7 cm in the medial to lateral direction.

The repair was accomplished as either a tongue-in-groove or an onlay reattachment of the cuff tendon to bone. The free edge of the detached tendon was either reimplanted into a trough at the base of the tuberosity or held securely opposed to the bone with transosseous sutures or absorbable anchors. For patients randomized to receive the SIS augmentation, the graft was extended over the repaired rotator cuff tendon and the tuberosity to which the tendon was attached.

To evaluate the success of the repair, patients underwent standardized magnetic resonance arthrography (MRA) of the rotator cuff at 1 year postoperatively to determine whether the defect had healed and, if it had not healed completely, whether the remaining full-thickness defect had increased by >5 mm in any dimension from the immediate postoperative appearance. If such a defect was detected, the repair was classified as having failed.

At 1 year, failures occurred in 52.9% (18/34) of the SIS group and in 65.4% (17/26) in the control group. The mean difference between groups for patient-reported outcomes was not significant.

They found no evidence that augmented rotator cuff repair provides superior outcomes in patients with moderate rotator cuff tears.

Comment: This study shows the high rate (>50%) of anatomic failure of repairs of moderate to large sized cuff tears, irrespective of the use of graft augmentation

The authors did not compare the clinical outcomes of the intact vs. the failed repairs; based on other studies, however, it is likely that the clinical outcomes were largely independent of the success of the repair. 

Our approach to these tears is shown in this link.

It is of interest that the authors apparently normalized the results of the different clinical outcome scales used and that the results with the different scales are quite similar: