Successful management of large or massive rotator cuff tears continues to present a clinical challenge. Because of the size and chronicity of tears, which contribute to poor soft-tissue quality, as well as advanced patient age and medical comorbidities, primary repair attempts are accompanied by high rates of tendon retearing. Interestingly, patients who undergo a repair attempt with subsequent failure still show improved functional outcomes postoperatively. However, those with a successful repair have the highest likelihood of subsequent clinical success and functional improvement, particularly regarding strength recovery.
Several treatment attempts have been described for surgical management of chronic and massive rotator cuff tears. These techniques have ranged from simple debridement and decompression to primary reverse total shoulder arthroplasty. Although rotator cuff repair reliably improves patient functional outcomes and satisfaction, it is accompanied by retear rates of 34% to 94%. One technique to improve tendon healing has been the use of synthetic or biologic patch reinforcement. These grafts are composed of a variety of materials, including synthetic graft, allograft, and xenograft options. The procedure can be performed either as augmentation (onlay) of a cuff repair, in which the patch is used to reinforce an anatomically reparable tear, or as interposition (intercalary), wherein the graft bridges the gap between the irreparable cuff and the humerus. However, studies have reported conflicting evidence regarding the success of this technique.
Our knowledge of outcomes associated with patch use is primarily based on Level III or IV studies that have reported on a variety of different outcome measures and other findings in small groups of patients. Moreover, each of these studies typically represents the experience of one surgeon or one institution and therefore, when taken alone, may not be an accurate reflection of patch use more broadly. A comprehensive review of these studies will help provide clinicians with the necessary data for counseling patients with large to massive rotator cuff tears and give patients and clinicians a better understanding of expected outcomes associated with these procedures.
The purposes of this study were to provide a comprehensive review of clinical outcomes and retear rates after patch use in rotator cuff repair and to determine the differences between available graft types and techniques. We hypothesized that incorporation of a patch graft at the time of rotator cuff repair would lead to improved clinical outcomes, with few complications and retears, after surgery.
Full Article: Outcomes After Patch Use in Rotator Cuff Repair