The results of using a tendon autograft as a new rotator cable for patients with a massive rotator cuff tear: a technical note and comparative outcome analysis

Ronald L Diercks,Egbert J D Veen,Cornelis T Koorevaar,Ellie B M Landman

doi:10.1186/s13018-020-1568-0

Abstract

BackgroundSeveral surgical reconstructive options are available to treat massive rotator cuff tears (MRCTs). The rotator cable has an important function and we evaluated the clinical result after arthroscopic reconstruction of the rotator cable with an autograft tendon.MethodsA prospective pilot study was performed with inclusion of four patients, average age of 64 years, with an irreparable MRCT. The patients underwent an arthroscopic reconstruction of the rotator cable with the use of the long head of biceps tendon autograft, except for one which was reconstructed with a hamstring tendon. Pre- and postsurgically, the Constant-Murley Score (CMS), Western Ontario Rotator Cuff Index (WORC), Simple Shoulder Test (SST), visual analog scale (VAS) scores, and an MRI was performed. Clinical results of the study group were compared with clinical results of comparable cohort of patients with a MRCT, treated non-operatively with physiotherapy.ResultsThe CMS score increased after surgery in three of the four patients. The improvement of CMS score was comparable to the improvement of the CMS score encountered in a comparable cohort. The MRI at 12 months follow-up showed that the reconstructed rotator cable was disintegrated in all patients and the rotator cuff was detached and retracted.ConclusionsIn our pilot study, arthroscopic reconstruction of the rotator cable using a tendon autograft failed over time and showed no clinical benefit in comparison to the non-operative treatment with physiotherapy.Trial registrationThe regional Medical Ethical Committee (Zwolle) gave approval at 14th of October 2016 and assigned no. 16.06100.

Highlights

Massive rotator cuff tears (MRCTs) are defined as cuff tears involving two or more cuff tendons or a retraction of ≥ 5cm [1]
We developed a technique to treat MRCTs by reconstructing the rotator cable with a long head of biceps tendon autograft [13]
We looked secondarily at the Simple Shoulder Test (SST) [15], Western Ontario Rotator Cuff Index (WORC) [16], and visual analog scale (VAS) [17] on pain, disability, and patient satisfaction

Summary

Introduction

Massive rotator cuff tears (MRCTs) are defined as cuff tears involving two or more cuff tendons or a retraction of ≥ 5cm [1]. A tenotomy or tenodesis of the long head of the biceps tendon is often performed as part of rotator cuff surgery. This offers the possibility of using the biceps tendon as a graft. Different studies used this tendon as a free graft or leaving the distal or proximal attachment intact, reporting significant improvement of function [10]. Several surgical reconstructive options are available to treat massive rotator cuff tears (MRCTs). The rotator cable has an important function and we evaluated the clinical result after arthroscopic reconstruction of the rotator cable with an autograft tendon

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