Results of reconstruction of massive irreparable rotator cuff tears using a fascia lata allograft

Abstract

Background:Despite the advances in surgical treatment options, massive rotator cuff (r-c) tears still represent a challenge for orthopedic surgeons. This study assesses the effectiveness of fascia lata allograft in reconstruction of massive and irreparable r-c tear and to evaluate the healing and functional outcomes.Materials and Methods:68 patients (38 men, 30 women, mean age 64.9 years) with massive or irreparable r-c tears were treated with placement of fascia lata allograft to fill the defect between February 2006 and February 2010. At 43 months followup they were evaluated clinically using the constant score, preoperatively and postoperatively. Magnetic resonance imaging (MRI) and ultrasound were used postoperatively, to assess the integrity of the allograft at the repair site. Postoperatively, standard rehabilitation protocol was followed with gradual restoration.Results:Postoperative constant score increased from 32.5 preoperatively to 88.7 postoperatively. The most important was the pain relief from 2.4 preoperatively to 14.1 postoperatively and range of motion. The results of the MRI were not reliable, but the ultrasound was satisfactory. Finally, there was no infection or rejection of the graft in any of the patients.Conclusions:Despite advances in surgical methods, there is still not a universally accepted treatment for massive and irreparable rotator cuff tears, because the standard methods have dubious results, with excessive retear rates and poor outcomes, necessitating the need for new repair strategies. We documented significant clinical improvement using fascia lata allograft in the repair of massive irreparable r-c tear, acting as scaffold to bridge the defect, enhancing the healing at the repair site.

Outcome Comparison of Graft Bridging and Superior Capsule Reconstruction for Large to Massive Rotator Cuff Tears: A Systematic Review

“…50 The remaining 15 GB studies investigated the effect of GB with synthetic grafts, 2,41,49,54 xenograft, 3,24,43 autograft, 40,51,52 and allograft. 6,14,23,29,31 Five SCR studies included observational case series of SCR with autograft 33,34,37 and allograft. 10,33,48 Other study characteristics are summarized in Tables 1 and 2 and Appendix Table A1 (available in the online version of the article).…”

“…A specific surgical technique should be performed on appropriately selected cases. Patients with conditions such as preoperative AHI <6 mm, 2,14 high-grade fatty infiltration of the rotator cuff, 40,50 and concomitant reparable subscapularis tear 3,24,43,46 should be carefully considered for GB or SCR.…”

Cryopreserved fascia lata allograft use in surgical facial reanimation: a retrospective study of seven cases

“…The absence of any osteotomy in this technique allows a reduction of the operative time and a lower risk of complications. The use of banked fascia lata graft has been described for many purposes: reconstruction of osteo-dural defect in neurosurgery, ptosis surgery, urinary incontinence, and rotator cuff tears repair [14][15][16][17][18]. Harvesting of autologous fascia lata can determine postoperative hematoma, wound infection, muscle herniation, weakness of hip flexion, numbness, pain, superficial phlebitis, and cosmetic concern due to the scar [19].…”

Irreparable rotator cuff tears: challenges and solutions

“…Dimitrios et al in 2015 have shown improvement in pain and CS (from 32.5 to 88.7) in 68 patients treated with interposition of fascia lata allograft for irreparable RCT with a follow-up of 12 months. At the end of 12 months ultrasound examination of 30 patients showed that only three of the patients had retear 61. Pandey et al in 2017 showed in their prospective nonrandomized cohort study of 26 patients having symptomatic irreparable RCT, managed with partial repairs in the first half of patients and with partial repair along with interposition GraftJacket dermal allograft in the second half of patients, that the postoperative scores for the latter group were significantly higher than the former group.…”