Clinical Outcomes in Patients Undergoing Revision Rotator Cuff Repair With Extracellular Matrix Augmentation

Abstract

Outcomes following revision surgery for failed rotator cuff repairs are far less predictable than and are associated with decreased patient satisfaction compared with primary repairs. Extracellular matrix augmentation (ECM) may improve the biologic potential for healing during revision repair. The authors examined clinical outcomes and healing rates based on postoperative imaging of patients who underwent revision open rotator cuff repair with an ECM patch for symptomatic recurrent rotator cuff tear. Twenty-four (77%) of 31 patients with a mean follow-up of 50 months (range, 30-112 months) completed post-revision surgery outcome questionnaires at a mean of 5.3 years after revision surgery, and 16 patients (67%) underwent a physical examination and repeat imaging (ultrasound or magnetic resonance imaging) at a mean of 4.2 years after revision surgery. Ten (63%) of those 16 patients were found to have failed revision rotator cuff repair on imaging, with American Shoulder and Elbow Surgeons (ASES) outcome measures that were significantly (P=.04) better in patients with confirmed intact repairs than those with confirmed failed revision repair. Outcome measures for all patients (n=24) included a mean ASES score of 67.2 (SD, 27.9) and a mean Single Assessment Numeric Evaluation (SANE) score of 66.9 (SD, 26.0). Based on these scores, excellent results were achieved in 24% of patients, good in 13%, fair in 21%, and poor in 42%. Results of this investigation demonstrated that augmentation of revision rotator cuff repair with an ECM patch through an open approach showed no significant improvement in outcomes when compared to historical reports without augmentation.

The clinical strategies for tendon repair with biomaterials: A review on rotator cuff and Achilles tendons

“…After 112 months, the augmentation with ECM patches showed no clinical improvements in comparison to the repair without augmentation, found in literature data, showing also a 42% of poor outcomes (Sears et al, 2015).…”

“…Thirty percent of the studies regarding RCT reached a maximum follow-up of 12 months (Barber, 2016;Bergeson et al, 2012;Encalada-Diaz et al, 2011;Rodeo et al, 2012;Rotini et al, 2011;Weber et al, 2013), while 1 (Basiglini et al, 2010) study evaluated outcomes at 12 months in Achilles tendon ruptures. Studies that exceeded 36 months of follow-up were five in RCT studies (44, 60, 68, or 112 months and 16 years;Badhe et al, 2008;Barber et al, 2011;Russo et al, 2011;Sears et al, 2015;Wong et al, 2010) and six (41, 60, 68, 81, and 117 months;Bibbo, 2010;Elias et al, 2009;Esenyel et al, 2014;Ibrahim, 2009;Nilsson-Helander et al, 2008;Wegrzyn et al, 2010) in Achilles tendon ones. Only one study showed a follow-up earlier than 12 months in RCT (Snyder et al, 2009) and five studies in Achilles tendon (3, 6, and 9 and 11 months;Branch, 2011;DeCarbo et al, 2010;Kearney & Costa, 2010;Ollivere et al, 2014;Stover et al, 2009).…”

“…Among the biological scaffolds, biological ECMs, of both human (allografts) and animal (xenografts) origin, were most employed (50% of all the studies) in both RCT and Achilles tendon defects (Badhe et al, 2008;Barber et al, 2012;Bibbo, 2010;Bond et al, 2008;Branch, 2011;Cho et al, 2014;DeCarbo et al, 2010;Kearney & Costa, 2010;Lee, 2008;Rotini et al, 2011;Sears et al, 2015;Snyder et al, 2009;Stover et al, 2009;Wong et al, 2010). Decellularized human dermis is the strongest among the biological ECMs and it was employed in large or massive RCT and in acute or chronic Achilles tendon ruptures.…”

Advances in biologic augmentation for rotator cuff repair

“…Despite the high rate at which these surgeries are performed and regardless of advances in technology and surgical techniques, retear after rotator cuff surgery remains a common problem. It has been reported that recurrent tears after rotator cuff repair range between 20% and 40% for small‐to‐medium tears and as high as 94% for large or chronic tears . Predisposing factors for retear include patient's age, size of tear, acuity/chronicity of tear, tendon quality, and muscle atrophy/fatty infiltration, all of which contribute to a poor capacity for healing—the fundamental culprit for failure of surgically reconstructed rotator cuff tendons .…”

“…small-to-medium tears and as high as 94% for large or chronic tears. [6][7][8][9][10] Predisposing factors for retear include patient's age, size of tear, acuity/chronicity of tear, tendon quality, and muscle atrophy/fatty infiltration, all of which contribute to a poor capacity for healing-the fundamental culprit for failure of surgically reconstructed rotator cuff tendons. 3,8 Healing of a torn rotator cuff is an extremely complex process, focused around the tendon-to-bone interface, called the enthesis.…”