A New Technique for Patch Augmentation of Rotator Cuff Repairs

Abstract

Massive rotator cuff tears defying primary repair have been treated with debridement, arthroscopic subacromial decompression, partial repair, muscle-tendon transfer, and joint prosthesis, among other techniques. However, the treatment results have not been satisfactory compared with those of small-to medium-sized rotator cuff tears; each procedure has its merits and demerits, and currently, there is no single established method. For massive rotator cuff tears defying primary repair, the arthroscopic patch graft procedure has been reported as an effective surgical procedure, and this procedure is chosen as the first-line treatment in our department. In this procedure, suture anchors are generally used to fix the patch graft to the footprint on the side of the greater tuberosity. However, tendon-to-bone healing is frequently difficult to achieve, and bone-to-bone healing seems more advantageous for the repair of the rotator cuff attachment site. To improve the results of treatment, a new patch graft procedure was developed, in which the iliotibial ligament with bone was collected at Gerdy's tubercle and the bone was anchored to the footprint on the side of the greater tuberosity. With this procedure, excellent results were obtained, although only short-term results are available at present. The technique and its results so far are reported. Despite the development of instruments and techniques in arthroscopic surgery, reconstruction of massive rotator cuff tears continues to be a challenge, with a high retear rate.1,2 Strengthening with a patch graft in such cases is an effective reconstructive procedure that can be expected to produce biological and biomechanical improvements. Recently, the use of several types of biological patches has been reportedd for instance, swine small intestinal mucous membrane (Restore Implant; DePuy, Warsaw, IN), human skin (GraftJacket; Wright Medical Technology, Arlington, TN), bovine skin (Tissue Mend; TEI Biosciences, Boston, MA), 3 and autologous fascia lata femoris. With these tissues, however, healing at the attachment site on the greater tuberosity of the rotator cuff might be difficult to achieve. To achieve bone-to-bone healing at the rotator cuff attachment site, the iliotibial ligament with bone as a patch graft was develoed as an alternative procedure. With the use of this patch, we believe that the purposes of patch strengthening could be achieved, including (1) increasing early strength, (2) providing a bridge for cellular ingrowth to improve the biological environment, and (3) not inducing a foreign-body reaction, thereby not interfering with the healing process.Our objective is to report the operative technique and describe the results of treatment because excellent short-term results are now available. The technique is demonstrated in Video 1. Surgical TechniqueThe patient underwent arthroscopy under general anesthesia in the beach-chair lateral-traction position. A secondary lesion in the scapulohumeral joint, if detected, was treated simultaneously. The tr...

Management of complications after rotator cuff surgery

“…One example of this is scaffolds that are designed to augment or bridge the muscletendon-bone unit and eventually incorporate into the host tissue. There are a variety of recent reports of utilizing synthetic scaffolds, biologic scaffolds, treated allograft/xenograft tissue, or autograft tissue to augment rotator cuff repairs [99][100][101][102][103][104][105][106][107]. However, many of these reports consist of technique articles or have short-term follow-up with no control group.…”

Reconstruction of large chronic rotator cuff tear can benefit from the bone–tendon composite autograft to restore the native bone–tendon interface

“…We did not evaluate the degrees of donor site morbidity. Considering creating donor site morbidity when harvesting Achilles–calcaneus autograft, in the future, an iliotibial band with Gerdy's tubercle [ 27 ] or iliac crest may be a better option in human as the composite autografts or a tissue engineered composite graft. Third, the supraspinatus muscle state was not evaluated before and after surgery.…”

Effect of human dermal allograft thickness on glenohumeral stability for superior capsular reconstruction in irreparable supraspinatus tears: A biomechanical analysis of the superior capsular reconstruction – A cadaveric study

“…6–9 For these irreparable cases, partial repairs, debridement, biceps tenotomy, tendon transfer and reverse shoulder arthroplasty have been utilized. 10 Bridging patch grafts, using human dermal allograft (HDA) patches, have also been used. Although some authors have reported good outcomes with this technique, others have reported high re-tear rates due to superior translation of the humerus from a lack of restoration of glenohumeral stability.…”