Interposition grafting for irreparable rotator cuff tears: Systematic review and specialist practice report

Abstract

The treatment of symptomatic irreparable rotator cuff tears poses significant challenges to both patients and shoulder surgeons. Although reverse shoulder arthroplasty provides reliably good outcomes in the elderly, it is not a good option in younger patients. Various surgical techniques have been proposed for the treatment of irreparable rotator cuff tears; however, no gold standard currently exists. Interposition grafting is used when the rotator cuff cannot be fully repaired onto its footprint, and the remaining defect is bridged with either an allograft, autograft, xenograft or a synthetic graft. This review aims to present the literature on the use of various interposition grafts and techniques to treat large or massive irreparable rotator cuff tears and provide a specialist practice report.

Association of Arthroscopically-Assisted Latissimus Dorsi Tendon Transfer with Implantation of a Subacromial Balloon Spacer for Patients with Irreparable Posterosuperior Rotator Cuff Tears

“…Irreparable massive rotator cuff tears represent one of the most significant challenges in shoulder surgery (1)(2)(3)(4). Over the years, several surgeries, or combinations thereof, have been proposed (5)(6)(7)(8)(9)(10). Among these, tendon transfers, initially studied for nerve injuries, are supported by biomechanical and clinical investigations describing their results in generally small to medium series (11)(12)(13)(14)(15)(16)(17)(18)(19).…”

The Number of Surgeons Using Superior Capsular Reconstruction for Rotator Cuff Repair Is Declining

“… 20 , 21 , 22 There is basic science and early clinical reports to support SCR and biologic augmentation. 6 , 9 , 20 , 21 , 22 However, they are being heavily marketed with a lack of clear indications and conclusive outcome improvement to perhaps justify the associated increased costs and technical challenges. 23 …”

“… 15 , 19 Clinical results in RCR have been variable with these biologic products, although there have been some early favorable reports with lower levels of evidence. 20 , 21 , 22 There is basic science and early clinical reports to support SCR and biologic augmentation. 6 , 9 , 20 , 21 , 22 However, they are being heavily marketed with a lack of clear indications and conclusive outcome improvement to perhaps justify the associated increased costs and technical challenges.…”

The changing landscape of rotator cuff surgery

“…When a cuff remains irreparable, it may be desirable to "bridge the gap" using an interposition graft. 11 Over the last decade, there has been…”