J Korean Orthop Assoc.  2013 Feb;48(1):70-77. 10.4055/jkoa.2013.48.1.70.

Management of Massive Rotator Cuff Tears: Role of the Tendon Augmentation

• Lee KW
• Bae KW
• Hwang YS

• KMID: 2106667
• DOI: http://doi.org/10.4055/jkoa.2013.48.1.70

Abstract

Rotator cuff tears are a common cause of debilitating pain, reduced shoulder function, and weakness. Despite improvements in the understanding of the disease process and advances in surgical treatment, recent studies have reported that healing of massive rotator cuff tears is not as predictable as that of smaller rotator cuff tears. These high failure rates are a result of both mechanical and biologic factors that may affect the patients' intrinsic capacity to heal. Most research studies have concentrated on tissue engineering as a means for improvement of healing in rotator cuff repair, including the use of scaffolds, growth factors, and mesenchymal stem cells. There has been much interest in the development of various scaffolds that provide adequate strength as well as stimulate and enhance healing potential. The purpose of this paper is to review the current basic science and clinical application of extracellular matrix scaffolds, which are currently the most widely used scaffolds for repair of rotator cuff tears.

Keyword

rotator cuff; massive; augmentation; extracellular matrix scaffolds

MeSH Terms

Biological Factors
Extracellular Matrix
Intercellular Signaling Peptides and Proteins
Mesenchymal Stromal Cells
Rotator Cuff
Shoulder
Tendons
Tissue Engineering
Biological Factors
Intercellular Signaling Peptides and Proteins

Figure

• 

  Figure 1 A 46-year-old female patient underwent open rotator cuff repair using an inter-positional acellular dermal matrix graft. (A) Pre-operative magnetic resonance imaging (MRI) shows a cuff tear with retraction. (B) Six-month follow-up MRI shows apparent integrity of the tendon.

Reference

1. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984. 66:563–567.

2. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000. 82:505–515.

3. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004. 86:219–224.

4. Adebajo AO, Nash P, Hazleman BL. A prospective double blind dummy placebo controlled study comparing triamcinolone hexacetonide injection with oral diclofenac 50 mg TDS in patients with rotator cuff tendinitis. J Rheumatol. 1990. 17:1207–1210.

5. Bigliani LU, Cordasco FA, McIlveen SJ, Musso ES. Operative treatment of failed repairs of the rotator cuff. J Bone Joint Surg Am. 1992. 74:1505–1515.

6. Franceschi F, Ruzzini L, Longo UG, et al. Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med. 2007. 35:1254–1260.

7. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br. 1991. 73:389–394.

8. Gill TJ, McIrvin E, Mair SD, Hawkins RJ. Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii. J Shoulder Elbow Surg. 2001. 10:247–249.

9. Levy O, Mullett H, Roberts S, Copeland S. The role of anterior deltoid reeducation in patients with massive irreparable degenerative rotator cuff tears. J Shoulder Elbow Surg. 2008. 17:863–870.

10. Ma CB, MacGillivray JD, Clabeaux J, Lee S, Otis JC. Biomechanical evaluation of arthroscopic rotator cuff stitches. J Bone Joint Surg Am. 2004. 86:1211–1216.

11. Adams JE, Zobitz ME, Reach JS Jr, An KN, Steinmann SP. Rotator cuff repair using an acellular dermal matrix graft: an in vivo study in a canine model. Arthroscopy. 2006. 22:700–709.

12. Coons DA, Alan Barber F. Tendon graft substitutes-rotator cuff patches. Sports Med Arthrosc. 2006. 14:185–190.

13. Derwin KA, Baker AR, Spragg RK, Leigh DR, Iannotti JP. Commercial extracellular matrix scaffolds for rotator cuff tendon repair. Biomechanical, biochemical, and cellular properties. J Bone Joint Surg Am. 2006. 88:2665–2672.

14. Aoki M, Miyamoto S, Okamura K, Yamashita T, Ikada Y, Matsuda S. Tensile properties and biological response of poly(L-lactic acid) felt graft: an experimental trial for rotator-cuff reconstruction. J Biomed Mater Res B Appl Biomater. 2004. 71:252–259.

15. Derwin KA, Codsi MJ, Milks RA, Baker AR, McCarron JA, Iannotti JP. Rotator cuff repair augmentation in a canine model with use of a woven poly-L-lactide device. J Bone Joint Surg Am. 2009. 91:1159–1171.

16. Koh JL, Szomor Z, Murrell GA, Warren RF. Supplementation of rotator cuff repair with a bioresorbable scaffold. Am J Sports Med. 2002. 30:410–413.

17. MacGillivray JD, Fealy S, Terry MA, Koh JL, Nixon AJ, Warren RF. Biomechanical evaluation of a rotator cuff defect model augmented with a bioresorbable scaffold in goats. J Shoulder Elbow Surg. 2006. 15:639–644.

18. Kimura A, Aoki M, Fukushima S, Ishii S, Yamakoshi K. Reconstruction of a defect of the rotator cuff with polytetrafluoroethylene felt graft. Recovery of tensile strength and histocompatibility in an animal model. J Bone Joint Surg Br. 2003. 85:282–287.

19. Chen JM, Willers C, Xu J, Wang A, Zheng MH. Autologous tenocyte therapy using porcine-derived bioscaffolds for massive rotator cuff defect in rabbits. Tissue Eng. 2007. 13:1479–1491.

20. Dejardin LM, Arnoczky SP, Clarke RB. Use of small intestinal submucosal implants for regeneration of large fascial defects: an experimental study in dogs. J Biomed Mater Res. 1999. 46:203–211.

21. Dejardin LM, Arnoczky SP, Ewers BJ, Haut RC, Clarke RB. Tissue-engineered rotator cuff tendon using porcine small intestine submucosa. Histologic and mechanical evaluation in dogs. Am J Sports Med. 2001. 29:175–184.

22. McAdams TR, Knudsen KR, Yalamanchi N, Chang J, Goodman SB. Deltoid flap combined with fascia lata autograft for rotator cuff defects: a histologic study. Knee Surg Sports Traumatol Arthrosc. 2007. 15:1144–1149.

23. Nicholson GP, Breur GJ, Van Sickle D, Yao JQ, Kim J, Blanchard CR. Evaluation of a cross-linked acellular porcine dermal patch for rotator cuff repair augmentation in an ovine model. J Shoulder Elbow Surg. 2007. 16:S184–S190.

24. Perry SM, Gupta RR, Van Kleunen J, Ramsey ML, Soslowsky LJ, Glaser DL. Use of small intestine submucosa in a rat model of acute and chronic rotator cuff tear. J Shoulder Elbow Surg. 2007. 16:S179–S183.

25. Sano H, Kumagai J, Sawai T. Experimental fascial autografting for the supraspinatus tendon defect: remodeling process of the grafted fascia and the insertion into bone. J Shoulder Elbow Surg. 2002. 11:166–173.

26. Schlegel TF, Hawkins RJ, Lewis CW, Motta T, Turner AS. The effects of augmentation with Swine small intestine submucosa on tendon healing under tension: histologic and mechanical evaluations in sheep. Am J Sports Med. 2006. 34:275–280.

27. Zalavras CG, Gardocki R, Huang E, Stevanovic M, Hedman T, Tibone J. Reconstruction of large rotator cuff tendon defects with porcine small intestinal submucosa in an animal model. J Shoulder Elbow Surg. 2006. 15:224–231.

28. Zheng MH, Chen J, Kirilak Y, Willers C, Xu J, Wood D. Porcine small intestine submucosa (SIS) is not an acellular collagenous matrix and contains porcine DNA: possible implications in human implantation. J Biomed Mater Res B Appl Biomater. 2005. 73:61–67.

29. Funakoshi T, Majima T, Suenaga N, Iwasaki N, Yamane S, Minami A. Rotator cuff regeneration using chitin fabric as an acellular matrix. J Shoulder Elbow Surg. 2006. 15:112–118.

30. Funakoshi T, Majima T, Iwasaki N, et al. Application of tissue engineering techniques for rotator cuff regeneration using a chitosan-based hyaluronan hybrid fiber scaffold. Am J Sports Med. 2005. 33:1193–1201.

31. Halder A, Zobitz ME, Schultz E, An KN. Structural properties of the subscapularis tendon. J Orthop Res. 2000. 18:829–834.

32. Halder A, Zobitz ME, Schultz F, An KN. Mechanical properties of the posterior rotator cuff. Clin Biomech (Bristol, Avon). 2000. 15:456–462.

33. Itoi E, Berglund LJ, Grabowski JJ, et al. Tensile properties of the supraspinatus tendon. J Orthop Res. 1995. 13:578–584.

34. Schneeberger AG, von Roll A, Kalberer F, Jacob HA, Gerber C. Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study. J Bone Joint Surg Am. 2002. 84:2152–2160.

35. Barber FA, Herbert MA, Boothby MH. Ultimate tensile failure loads of a human dermal allograft rotator cuff augmentation. Arthroscopy. 2008. 24:20–24.

36. Gilbert TW, Sellaro TL, Badylak SF. Decellularization of tissues and organs. Biomaterials. 2006. 27:3675–3683.

37. Derwin KA, Baker AR, Spragg RK, Leigh DR, Farhat W, Iannotti JP. Regional variability, processing methods, and biophysical properties of human fascia lata extracellular matrix. J Biomed Mater Res A. 2008. 84:500–507.

38. Baker AR, Abreu EL, Mascha E, Derwin KA. Homotypic variation of canine flexor tendons: implications for the design of experimental studies in animal models. J Biomech. 2004. 37:959–968.

39. Badylak S, Arnoczky S, Plouhar P, et al. Naturally occurring extracellular matrix as a scaffold for musculoskeletal repair. Clin Orthop Relat Res. 1999. 367 Suppl. S333–S343.

40. Musahl V, Abramowitch SD, Gilbert TW, et al. The use of porcine small intestinal submucosa to enhance the healing of the medial collateral ligament--a functional tissue engineering study in rabbits. J Orthop Res. 2004. 22:214–220.

41. Badylak SF, Tullius R, Kokini K, et al. The use of xenogeneic small intestinal submucosa as a biomaterial for Achilles tendon repair in a dog model. J Biomed Mater Res. 1995. 29:977–985.

42. Badylak SF, Kropp B, McPherson T, Liang H, Snyder PW. Small intestional submucosa: a rapidly resorbed bioscaffold for augmentation cystoplasty in a dog model. Tissue Eng. 1998. 4:379–387.

43. Record RD, Hillegonds D, Simmons C, et al. In vivo degradation of 14C-labeled small intestinal submucosa (SIS) when used for urinary bladder repair. Biomaterials. 2001. 22:2653–2659.

44. Allman AJ, McPherson TB, Badylak SF, et al. Xenogeneic extracellular matrix grafts elicit a TH2-restricted immune response. Transplantation. 2001. 71:1631–1640.

45. Badylak SF, Wu CC, Bible M, McPherson E. Host protection against deliberate bacterial contamination of an extracellular matrix bioscaffold versus Dacron mesh in a dog model of orthopedic soft tissue repair. J Biomed Mater Res B Appl Biomater. 2003. 67:648–654.

46. Beniker D, McQuillan D, Livesey S, et al. The use of acellular dermal matrix as a scaffold for periosteum replacement. Orthopedics. 2003. 26:s591–s596.

47. Macleod TM, Williams G, Sanders R, Green CJ. Histological evaluation of Permacol as a subcutaneous implant over a 20-week period in the rat model. Br J Plast Surg. 2005. 58:518–532.

48. Sclamberg SG, Tibone JE, Itamura JM, Kasraeian S. Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa. J Shoulder Elbow Surg. 2004. 13:538–541.

49. Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ. Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. J Bone Joint Surg Am. 2006. 88:1238–1244.

50. Dopirak R, Bond JL, Synder SJ. Arthroscopic total rotator cuff replacement with an acellular human dermal allograft matrix. Int J Shoulder Surg. 2007. 1:7–15.

51. Burkhead WZ, Schiffern SC, Krishnan SG. Use of GraftJacket as an augmentation for massive rotator cuff tears. Semin Arthroplasty. 2007. 18:11–18.

52. Bond JL, Dopirak RM, Higgins J, Burns J, Snyder SJ. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy. 2008. 24:403–409.

53. Badhe SP, Lawrence TM, Smith FD, Lunn PG. An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elbow Surg. 2008. 17:35S–39S.

54. Soler JA, Gidwani S, Curtis MJ. Early complications from the use of porcine dermal collagen implants (Permacol) as bridging constructs in the repair of massive rotator cuff tears. A report of 4 cases. Acta Orthop Belg. 2007. 73:432–436.