Staged Arthroscopic Rotator Cuff Repair with a Bridging Acellular Human Dermal Graft in the Treatment of Infection Following Open Rotator Cuff Repair: A Case Report.

Abstract

Although infection after rotator cuff repair occurs infrequently, it can be a catastrophic complication. To the best of my knowledge, there are only a small number of reports in the literature regarding management of these infections, and none of these report the outcome of a staged arthroscopic approach1-6. Once the infection has resolved, reconstruction of the residual rotator cuff defect can present a substantial challenge for the treating orthopaedic surgeon. The purpose of this report is to present the clinical, functional, and magnetic resonance imaging (MRI) results of an all-arthroscopic approach for the management of a massive rotator cuff tear defect resulting from an infection after an initial open rotator cuff repair. The patient was informed that data concerning his case would be submitted for publication, and he provided consent. A thirty-two-year-old right-hand dominant man with medical comorbidities including diabetes, hypertension, and obesity (body-mass index [BMI] > 40) was referred to our shoulder clinic in October 2009 for a persistent deep left shoulder infection after an open rotator cuff repair. The patient had initially been treated with an open rotator cuff repair with a mesh reinforcement graft in August 2009. The patient had experienced persistent pain and had developed a draining wound, which had been managed with serial debridement, wound care, and intravenous antibiotics for a period of three weeks, followed by oral antibiotics (Augmentin [amoxicillin and clavulanate] and then Levaquin [levofloxacin]) and dressing changes. Previous culture specimens had been positive for Propionibacterium acnes . Despite the aggressive surgical care and serial debridement, the patient had a persistent arthrocutaneous fistula along with dehiscence of the deltoid muscle. He then was referred to our tertiary care shoulder clinic for definitive management. In addition to a thorough history and physical examination, we also obtained an infectious disease consultation …