Effect of Fatty Degeneration of the Infraspinatus on the Efficacy of Arthroscopic Patch Autograft Procedure for Large to Massive Rotator Cuff Tears

Daisuke, Mori; Funakoshi, Noboru; Yamashita, Fumiyoshi; Wakabayashi, Tsuguru

doi:10.1177/0363546515569680

Cited by 52 publications

(73 citation statements)

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“…However, since many studies reported that the retear rate increases with severe fatty degeneration and most massive rotator cuff tears are accompanied by chronic fatty degeneration, 3) the severity of fatty degeneration should be considered when graft is used. 23) In a study by Gupta et al, 7) the retear rate was only 20%–24% when ADP grafts were used for selected patients with low fatty degeneration. Moreover, Mori et al 8) performed rotator cuff repairs using autogenic fascia lata and reported that 8.3% of patients showed retears at the final follow-up.…”

Section: Discussionmentioning

confidence: 98%

“…However, this study also included patients with grade one or two fatty degeneration in the infraspinatus according to the Goutallier classification, which was a limitation. When the same authors 23) investigated the healing failure rate in patients with high fatty degeneration, the retear rate was 89.4%, indicating that this approach was not suitable in cases with high grades of fatty degeneration. Considering the results of those studies, we think that the high healing failure rate (75%) in group II could be attributable to the fact the patients had a mean GFDI of 2.7.…”

Section: Discussionmentioning

confidence: 99%

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Bridging Graft in Irreparable Massive Rotator Cuff Tears: Autogenic Biceps Graft versus Allogenic Dermal Patch Graft

Rhee

2017

Clin Orthop Surg

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BackgroundFew comparative studies have reported on the use of biologic grafts for irreparable massive rotator cuff tears. The purpose of this study was to assess the results of arthroscopic bridging graft in irreparable massive rotator cuff tears using an autogenic long head of biceps tendon (LHBT) or an allogenic dermal patch (ADP).MethodsWe retrospectively reviewed 24 patients treated using the LHBT (group I) and eight patients with complete rupture of the LHBT treated using an ADP (group II) since 2011. Preoperative Goutallier's fatty degeneration, range of motion (ROM), visual analogue scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score were assessed and healing failure was evaluated at 1 year after surgery by ultrasonography or magnetic resonance imaging.ResultsThe mean fatty degeneration in groups I and II was 3.9 and 3.6 for the supraspinatus (p = 0.288), 2.7 and 2.9 for the infraspinatus (p = 0.685), 0.9 and 1.3 for the subscapularis (p = 0.314), and 1.3 and 3.0 for the teres minor (p = 0.005), respectively. Subscapularis tears were found in 8 patients (33.3%) in group I and in 7 patients (87.5%) in group II (p = 0.023). Mean ROMs and functional scores improved significantly in group I (forward flexion: 121.7° to 153.3°, p = 0.010; external rotation: 32.7° to 52.7°, p = 0.001; external rotation at 90°: 63.3° to 74.5°, p = 0.031; internal rotation: T10.5 to T9.3, p = 0.045; VAS: 7.0 to 1.1, p < 0.001; ASES score: 45.4 to 81.6, p = 0.028; and Quick DASH score: 50.0 to 14.2, p = 0.017), whereas only VAS showed significant improvement in group II (from 5.9 to 2.0, p = 0.025) and ROMs and other functional scores increased without statistical significance in the group. Healing failure was found in 13 patients (54.2%) in group I and in 6 patients (75.0%) in group II (p = 0.404).ConclusionsThe surgeon should prudently choose surgical options for irreparable massive rotator cuff tears, especially in patients with severe fatty degeneration in the teres minor or combined biceps and subscapularis tears.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Bridging Graft in Irreparable Massive Rotator Cuff Tears: Autogenic Biceps Graft versus Allogenic Dermal Patch Graft

Rhee

2017

Clin Orthop Surg

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“…76 In a cohort study, the effect of augmenting arthroscopic repairs of large to massive rotator cuff tears with a fascia lata autograft patch was evaluated, distinguishing between shoulders with low-grade and high-grade fatty infiltration. 77 Interestingly, patch augmentation was not beneficial for massive tears with highgrade fatty infiltration, 77 highlighting the importance of considering the muscle quality when applying tissue engineering strategies intended to support the healing tendonbone interface. To that end, restoring the structure and function of the degenerated muscle in the context of a chronic rotator cuff tear may further enhance the benefit of a scaffold applied to augment the surgical repair.…”

Section: Mechanical Augmentation Of the Surgical Repairmentioning

confidence: 99%

“…For instance, no benefit to augmenting repairs with a fascia lata autograft patch was found in patients with high-grade fatty infiltration of their muscles. 77 Preclinical models employing aged animals may also be of value, as older animals also experience age-associated exacerbation in muscle stiffness 241 and fatty infiltration 116 in addition to reduced healing capacity. 242…”

Section: Present Challenges and Future Perspectivesmentioning

confidence: 99%

The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears

Rothrauff

Pauyo

Debski

et al. 2017

Tissue Engineering Part B: Reviews

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The torn rotator cuff remains a persistent orthopedic challenge, with poor outcomes disproportionately associated with chronic, massive tears. Degenerative changes in the tissues that comprise the rotator cuff organ, including muscle, tendon, and bone, contribute to the poor healing capacity of chronic tears, resulting in poor function and an increased risk for repair failure. Tissue engineering strategies to augment rotator cuff repair have been developed in an effort to improve rotator cuff healing and have focused on three principal aims: (1) immediate mechanical augmentation of the surgical repair, (2) restoration of muscle quality and contractility, and (3) regeneration of native enthesis structure. Work in these areas will be reviewed in sequence, highlighting the relevant pathophysiology, developmental biology, and biomechanics, which must be considered when designing therapeutic applications. While the independent use of these strategies has shown promise, synergistic benefits may emerge from their combined application given the interdependence of the tissues that constitute the rotator cuff organ. Furthermore, controlled mobilization of augmented rotator cuff repairs during postoperative rehabilitation may provide mechanotransductive cues capable of guiding tissue regeneration and restoration of rotator cuff function. Present challenges and future possibilities will be identified, which if realized, may provide solutions to the vexing condition of chronic massive rotator cuff tears.

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“…Mori et al 13 reported 10.5% healing rate with fascia lata AU in a series of patients with severe fatty degeneration (Goutallier 3 or 4)49 50 of the supraspinatus and infraspinatus. However, when they evaluated a similar series of patients with severe fatty degeneration isolated to only the supraspinatus, a significantly higher healing rate (73.1%) was obtained 12.…”

Section: Discussionmentioning

confidence: 97%

Healing rate and clinical outcomes of xenografts appear to be inferior when compared to other graft material in rotator cuff repair: a meta-analysis

Herrera

Woodmass

et al. 2016

Journal of ISAKOS

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Effect of Fatty Degeneration of the Infraspinatus on the Efficacy of Arthroscopic Patch Autograft Procedure for Large to Massive Rotator Cuff Tears

Abstract: The arthroscopic fascia lata autograft patch procedure was not as beneficial for massive RCTs with high-grade fatty degeneration of the supraspinatus and infraspinatus as other treatment options that produce similar functional results.

Cited by 52 publications

References 50 publications

Bridging Graft in Irreparable Massive Rotator Cuff Tears: Autogenic Biceps Graft versus Allogenic Dermal Patch Graft

Bridging Graft in Irreparable Massive Rotator Cuff Tears: Autogenic Biceps Graft versus Allogenic Dermal Patch Graft

The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears

Healing rate and clinical outcomes of xenografts appear to be inferior when compared to other graft material in rotator cuff repair: a meta-analysis

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