Massive Rotator Cuff Tears With Short Tendon Length Can Be Successfully Repaired Using Synthetic Patch Augmentation.

Abstract

Choosing the optimal treatment for massive rotator cuff tears (MRCT) still poses a surgical problem. In MRCT with good muscle quality, but short tendon length, non-augmented repairs lead to high failure rates of up to 90%. The aim of the study was to evaluate mid-term clinical and radiological outcomes of massive rotator cuff tears with good muscle quality, but short tendon length, which were repaired with synthetic patch augmentation. A retrospective study of patients who underwent arthroscopic or open rotator cuff repairs with patch augmentation between 2016 and 2019 was performed. We included patients older than 18 years, who presented with MRCT confirmed by an MRI arthrogram showing good muscle quality (Goutallier ≤II) and short tendon length (length <15mm). Constant-Murley score (CS), subjective shoulder value (SSV) and range of motion (ROM) were compared pre- and postoperatively. We excluded patients older than 75 years or with presence of rotator cuff arthropathy Hamada ≥ 2a. Patients were followed up for two years minimum. Clinical failures were defined by re-operation, forward flexion <120 or a relative CS < 70. Structural integrity of the repair was assessed using an MRI. Comparison between different variables and outcomes was performed using Wilcoxon-Mann-Whitney and Chi square tests. Fifteen patients (mean age 57 years, 13 (86.7%) male, 9 (60%) right shoulders) were reevaluated with a mean follow-up of 43.8 months (27-55 months). There was a significant improvement in the absolute CS (from 33 to 81 points, p=0.03), the relative CS (from 41% to 88%, p=0.04), the SSV (from 31% to 93% p=0,007) and forward flexion (from 111° to 163°, p=0.004) but not in external rotation (from 37° to 38°, p=0.5). There were three clinical failures (one atraumatic, two traumatic) with re-operations (two reverse total shoulder arthroplasties and one refixation). Structurally, there were three Sugaya grade 4 and five Sugaya grade 5 re-ruptures resulting in a retear rate of 53%. The presence of a complete or partial re-rupture was not associated with inferior outcomes compared to intact cuff repairs. There were no correlations between the grade of retraction, muscle quality or rotator cuff tear configuration and re-rupture or functional outcomes. Patch augmented cuff repair leads to a significant improvement of functional and structural outcomes. Partial re-ruptures were not associated with inferior functional outcomes. Prospective randomized trials are needed to confirm the results found in our study.