Arthroscopic ePTFE Patch Repair for Irreparable Rotator Cuff Tears

Abstract

Introduction: Massive rotator cuff tears are difficult to manage. A treatment option is the use of a synthetic patch as an interpositional bridge to restore the continuity of the cuff defect. The aim of this paper was to evaluate the early clinical results of these techniques compared with the standard direct tendon to bone repair. Methods:A retrospective case-controlled study was performed on patients with massive (Z15 cm 2 ) rotator cuff tears who underwent an arthroscopic direct tendon to bone repair and patients with irreparable rotator cuff tears who underwent arthroscopic patch interposition using multiple mattress technique or a novel weave technique at the patch to tendon interface. Results:Of the 801 arthroscopic rotator cuff repairs, 37 patients met the inclusion criteria. Of these, 21 underwent direct tendon to bone repair without interpositional patches and 16 underwent interpositional expanded polytetrafluoroethylene (ePTFE) patch repairs (8 with multiple mattress sutures and 8 with a weave repair at the patch to tendon interface). No differences were noted between the 3 groups in terms of patient age (66 ± 3, 64 ± 3, and 63 ± 5 y, respectively), rotator cuff tears sizes (25 ± 3, 25 ± 6, and 19 ± 4 cm 2 ), preoperative subjective pain and function, and strength and range of motion. Overall subjective pain and function improved in all 3 repair groups at 6 months postoperatively (P < 0.05). Supraspinatus strength was superior in the weave technique when compared with the direct tendon to bone (P < 0.001) and the multiple mattress technique (P < 0.001). External rotation strength was better with the weave technique over the direct tendon to bone repair at 6 months (P = 0.01). There was more range of motion in external rotation in the weave technique over the direct tendon to bone repair (P < 0.001) and the multiple mattress technique (P = 0.04). Operative times with the ePTFE reconstructions (64 ± 7 min with the multiple mattress repair and 46 ± 3 min with the weave repair) were longer than the direct tendon to bone repair (33 ± 3 min). At 6 months, ultrasound showed that 10/21 repairs were intact in the direct tendon to bone repair group, whereas all (16/16) repairs with the ePTFE grafts were intact (P = 0.01). Conclusions:The weave arthroscopic method for attaching a synthetic patch to the torn edges of an irreparable rotator cuff tear was faster to perform and gave better supraspinatus and external rotation strength when compared with the multiple mattress repair at 6 months after repair. Tendons repaired with an ePTFE patch were much less likely to retear when compared with tendons repaired directly to the bone.

Synthetic Patch Rotator Cuff Repair: A 10-year Follow-Up

“…At 6 months postoperatively, over 50% (11 out of 21) of patients who underwent a direct tendon to bone repair had a re-tear on imaging compared to 0% (0 out of 16) of patients whose repair was performed using a synthetic patch. Six months after surgery, the patch repair group (weave method) had better shoulder strength in abduction of the scapular plane and external rotation compared to the direct tendon to bone repair group [30].…”

Biomechanical comparison of expanded polytetrafluoroethylene (ePTFE) and PTFE interpositional patches and direct tendon-to-bone repair for massive rotator cuff tears in an ovine model

“…Therefore, this technique was used in the present study. Clinical studies by our institute have also shown promising results with a 6month follow-up of 16 patients; 13 eight following weave suture technique and eight following a mattress suture technique at the patch-to-tendon interface found superior abduction strength following weave suturing technique repair. A long-term, 10-year clinical follow-up described healing at the patch-to-tendon interface in four of five patients (80%).…”

“…17 Polytetrafluoroethylene (PTFE) felt and expanded PTFE (ePTFE) fabric were selected because these are the two materials that have been used in surgery by the senior author with good clinical outcomes. 13,16 Material testing Six isolated ovine infraspinatus, six BARD PTFE felt samples and six Gore-Tex PTFE samples were prepared for comparison of their biomechanical properties against the control ovine tendon.…”

“…9,11 Visuri et al also reported two instances of cystic degradation of the greater tuberosity following the use of a carbon fibre patch for rotator cuff repair. 12 Several studies have described the technique and outcomes of interpositional synthetic patch rotator cuff tears, [13][14][15] including a 10-year follow-up of five patients. 16 However, no study has compared the biomechanical properties of synthetic materials to native tendon in an effort to identify the ideal material and material characteristics for use in interpositional synthetic patch repair.…”

A Comparison of Two Arthroscopic Techniques for Interpositional Polytetrafluoroethylene Patch Repair for Massive Irreparable Rotator Cuff Tears: Speed and Biomechanics

“…Both the multiple-mattress technique [14] and the later weave technique [13] were used at our institution for the arthroscopic insertion of the patch in ISPR. The multiplemattress repair (64 min) and the weave technique (46 min) took significantly longer to perform than tendon-to-bone repairs (33 min) [13]. Furthermore, both techniques were complex and relied on surgical expertise to be performed effectively [12,14].…”