Friday, November 23, 2012

Does Augmentation with a Reinforced Fascia Patch Improve Rotator Cuff Repair Outcomes? CORR

Does Augmentation with a Reinforced Fascia Patch Improve Rotator Cuff Repair Outcomes? CORR

This is a study of the surgical repair of surgical incomplete (2/3 rds) release and acute repair of the infraspinatus tendon in young dogs. Thus it is not a study of 'rotator cuff repair outcomes' and the model is quite different than the clinical situation we encounter where the issue is usually a chronic defect with tendon tissue loss in individuals older than 60 years. The authors acknowledged support of the Musculoskeletal Transplant Foundation, which makes the patches used in this series of experiments.

Identical lesions were created on each side of the dogs' shoulders, one one side, the repair was reinforced with a "novel poly-L-lactic acid-reinforced (human) fascia patch" and the other without. It is of note that this patch was applied over a robust tendon to bone repair and was not used to bridge a defect in the rotator cuff or to reinforce a tenuous repair.  At 12 weeks, the ultimate load of augmented  repairs was 16% less than nonaugmented repairs.

Curiously, the authors conclude that "... these findings support the possibility that reinforced fascia patches would incorporate and provide (at least early) mechanical augmentation to rotator cuff repair in human patients." However, the value (benefit to the patient/cost) of the patches now commercially in rotator cuff surgery remains to be demonstrated in the clinical situation.

The most interesting aspect of this paper was the retraction of the tendon stump from the osseous repair site - even in this ideal rotator cuff repair model.  As early as three months after the repairs, 4 of 11 non augmented repairs and 6 of 11 augmented repairs had retracted by a centimeter or more! These results again emphasize how difficult it is to achieve durable reconstruction of the anatomy of the tendon insertion - even under idealized circumstances.

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