These authors point to the prevalence of retears after cuff repair: "Galatz et al reviewed 18 patients after arthroscopic repair of tears > 2 cm using a single-row technique and ultrasound evaluation after 12 months and found 17 of 18 retears. Lee et al reported retear after arthroscopic double-row repair in 30 of 62 (48.4%). In patients aged > 60 years, the retear rate was 62.5%, and medium to large tears retore in 27 of 51 (53%). Tashjian et al reported arthroscopic repair of 2-tendon tears evaluated by ultrasound imaging and found 64% retears after double-row repair. Bishop et al evaluated open and arthroscopic rotator cuff repair by MRI. Large rotator cuff tears had a retear rate of 38% in the open group and 76% in the arthroscopic group."
Against this background they conducted a study of 61 shoulders with large rotator cuff tears (3 to 5 cm) surgically repaired and reinforced with a extracellular matrix (ECM) graft. The average tear size was 3.8 cm.
Three patients underwent surgical revision. Complications included 1 deep infection.
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.
Comment: This is a carefully done followup study but does not offer the opportunity to compare outcomes of repairs with and without application of the ECM.
It is of interest that the functional outcomes were not different for shoulders with and without retears, as shown below.
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