Clin Orthop Surg.  2017 Dec;9(4):497-505. 10.4055/cios.2017.9.4.497.

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

• Rhee SM
• Oh JH

• KMID: 2412251
• DOI: http://doi.org/10.4055/cios.2017.9.4.497

Abstract

BACKGROUND
Few 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).
METHODS
We 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.
RESULTS
The 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).
CONCLUSIONS
The 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.

Keyword

Rotator cuff; Massive tear; Patch graft; Biceps graft

MeSH Terms

Adipose Tissue/*pathology
Aged
Arthroscopy
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Musculoskeletal Pain/etiology
Range of Motion, Articular
Retrospective Studies
Rotation
Rotator Cuff Injuries/complications/diagnostic imaging/*physiopathology/*surgery
Shoulder Joint/diagnostic imaging/*physiopathology
*Skin Transplantation
Tendons/*transplantation
Transplantation, Autologous
Transplantation, Homologous
Ultrasonography
Wound Healing

Figure

• 

  Fig. 1 (A) The torn rotator cuff was unable to be mobilized. (B) The threads were passed through the retracted rotator cuff tendon and matching sutures were penetrated through the long head of biceps tendon. (C) Final construct of rotator cuff reconstruction using the long head of biceps tendon graft.

• 

  Fig. 2 (A) Threads penetrated the torn rotator cuff which was unable to be mobilized. (B) After introducing the graft into the joint, one thread from the rotator cuff and the matching thread from the allogenic patch graft were retrieved and tied. (C) Suture anchors at the lateral border of the graft were inserted and tied in single-row repair.

• 

  Fig. 3 Bar chart demonstrating healing failure rates. Retear was found in 13 of 24 for group I (54.2%) and 6 of 8 for group II (75.0%) (p = 0.040).

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