Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original Article With Video IllustrationArthroscopic Surgery of Irreparable Large or Massive Rotator Cuff Tears With Low-Grade Fatty Degeneration of the Infraspinatus: Patch Autograft Procedure Versus Partial Repair Procedure
Section snippets
Patient Selection
The study protocol was approved by our institutional review board, and informed consent for inclusion in the study was obtained from all patients. Data were prospectively collected in our database and retrospectively reviewed. Fifty-seven consecutive patients with irreparable large or massive posterosuperior RCTs underwent an arthroscopic patch graft procedure or partial repair by a single surgeon between June 2007 and May 2010 because it was not feasible to completely cover the humeral head
Preoperative Patient Demographic Characteristics
The preoperative characteristics of patients who underwent the patch graft procedure (group A) or partial repair (group B) are shown in Table 1. There were no significant differences between the groups in terms of sex, age, follow-up period, dominant hand, Workers' Compensation status, smoking status, existence of a partial SSC tear, mediolateral tear diameter, anteroposterior tear diameter, performance of biceps tenotomy, performance of biceps tenodesis, or GFDI (P > .05 for all).
MRI Findings
Postoperative
Discussion
Because preoperative fatty degeneration of the rotator cuff muscles is an important predictor of poor outcomes after repair of large or massive RCTs,4, 5, 14, 15 it is appropriate to compare the outcomes of procedures between shoulders with a similar level of fatty degeneration. In this study, therefore, we compared 2 procedures in shoulders with large or massive RCTs with low-grade fatty degeneration (stages 1 and 2) of the infraspinatus according to Goutallier et al.4, 15 A similar indication
Conclusions
In arthroscopic surgery for irreparable large or massive RCTs with low-grade fatty degeneration (stages 1 and 2) of the infraspinatus, the patch graft procedure showed an 8.3% retear rate for the repaired ISP with both improved clinical scores and recovery of muscle strength, whereas the partial repair had a retear rate of 41.7% (P = .015).
Acknowledgment
The authors are grateful to Toshihisa Furukawa, M.D., for the statistical analyses and to Mutsumi Nishida, Ph.D., for his valuable discussion.
References (38)
- et al.
Massive rotator cuff tears: Debridement versus repair
Orthop Clin North Am
(1997) - et al.
Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: A study in thirteen patients
J Shoulder Elbow Surg
(2007) - et al.
Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears
J Shoulder Elbow Surg
(2003) - et al.
Massive rotator cuff tears: The result of partial rotator cuff repair
J Shoulder Elbow Surg
(2005) - et al.
Arthroscopic debridement of massive irreparable rotator cuff tears
Arthroscopy
(2008) - et al.
A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair
Arthroscopy
(2012) - et al.
Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation
Arthroscopy
(2008) - et al.
Partial repair of irreparable supraspinatus tendon tears: Clinical and radiographic evaluations at long-term follow-up
J Shoulder Elbow Surg
(2011) - et al.
Scoring systems for the functional assessment of the shoulder
Arthroscopy
(2003) - et al.
Rotator cuff integrity after arthroscopic repair for large tears with less-than-optimal footprint coverage
Arthroscopy
(2009)
Functional and magnetic resonance imaging evaluation after single-tendon rotator reconstruction
J Shoulder Elbow Surg
Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation
Arthroscopy
Experimental fascial autografting for the supraspinatus tendon defect: Remodeling process of the grafted fascia and the insertion into bone
J Shoulder Elbow Surg
Arthroscopic treatment of massive rotator cuff tears: Clinical results and biomechanical rationale
Clin Orthop Relat Res
Fatty muscle degeneration cuff ruptures. Pre- and postoperative evaluation by CT scan
Clin Orthop Relat Res
Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study
J Bone Joint Surg Am
Massive rotator cuff tears: Functional outcome after debridement or arthroscopic partial repair
J Orthop Traumatol
Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears
J Bone Joint Surg Am
Biomechanical and biologic augmentation for the treatment of massive rotator cuff tears
Am J Sports Med
Cited by (147)
Clinical outcomes of medialized single-row repair with fascia lata graft augmentation for large and massive rotator cuff tears
2024, Journal of Shoulder and Elbow SurgeryTop 50 most impactful publications on massive rotator cuff tears
2024, JSES Reviews, Reports, and TechniquesMidterm outcomes of autologous bridging of rotator cuff tears with an autologous tendon patch (TEAR patch)
2024, Journal of Shoulder and Elbow SurgeryMini-Open Fascia Lata Interposition Graft Results In Superior 2-Year Clinical Outcomes When Compared to Arthroscopic Partial Repair for Irreparable Rotator Cuff Tear: A Single-Blind Randomized Controlled Trial
2024, Arthroscopy - Journal of Arthroscopic and Related SurgeryBridging repair reinforced with artificial ligament as an internal brace for irreparable massive rotator cuff tears
2024, Journal of Shoulder and Elbow SurgeryArthroscopic Repair of Massive Rotator Cuff Tears Leads to Functional Improvement in Most Patients at 4-Year Follow-up
2023, Arthroscopy, Sports Medicine, and Rehabilitation
The authors report that they have no conflicts of interest in the authorship and publication of this article.