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

Rhee, Sung Min; Oh, Joo Han

doi:10.4055/cios.2017.9.4.497

Cited by 44 publications

(38 citation statements)

References 28 publications

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“…Despite this, they too demonstrated improved functional scores in University of California, Los Angeles (UCLA) shoulder score. Previous studies that can provide a direct comparison to our data showed similar functional scores postoperatively: Modi et al7) showed a mean Constant score of 42; Rhee and Oh11) showed a comparable QuickDASH score of 20.9 ± 3.6 and also a comparable retear or failure rate seen on MRI of 75% in their “bridging” group at 1 year postoperatively. We think that the functional scores and patient-perceived improvement are due to the graft preventing proximal migration and abutment of the humeral head and are likely to be short-lived as the graft becomes thin, macerated, and tears away from the tendinous stump.…”

Section: Discussionsupporting

confidence: 80%

Failure of Dermal Allograft Repair of Massive Rotator Cuff Tears in Magnetic Resonance Imaging and Clinical Assessment

et al. 2019

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Background Massive retracted rotator cuff tears represent a therapeutic dilemma, particularly in the young and middle-aged patients who are not appropriate for a reverse total shoulder replacement. Interposition grafting using human dermal allograft offers an alternative treatment. Methods A retrospective review of all patients who underwent interposition grafting using human dermal allograft between December 2013 and May 2015 for massive rotator cuff tears at our tertiary referral center was performed. Preoperative and 6 month postoperative magnetic resonance imaging (MRI) assessments were performed in all patients, with postoperative graft integrity being the primary outcome measure. Clinical evaluation was performed using the Oxford shoulder score, Constant score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results The mean age at the time of follow-up was 54 years. On MRI, 84% of grafts were seen to have failed at 6 months. Strength was grossly reduced on the operative side when supraspinatus and subscapularis were tested; despite this, Constant score (mean, 48.2) was comparable to that in the previous reports. DASH and Oxford scores were a mean of 24.94 and 37.16, respectively. Conclusions Based on these results, in particular the MRI findings, we cannot advocate the use of dermal allograft as an interposition graft for the repair of massive rotator cuff tears.

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Section: Discussionsupporting

confidence: 80%

Failure of Dermal Allograft Repair of Massive Rotator Cuff Tears in Magnetic Resonance Imaging and Clinical Assessment

et al. 2019

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“…Until now, many studies have reported on the procedures used for massive rotator cuff tear, e.g., debridement [1], biceps tenotomy [2,3], partial repair [4,5], patch graft [6][7][8], latissimus dorsi transfer [9,10] and reverse total shoulder arthropathy (RSA) [11,12]. However, it is not easy to obtain satisfactory results via any of the surgical methods and symptoms, such as dysfunction and pain, may persist after surgery.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear

Ohta

Katoh

Onochi

2019

Arch Orthop Trauma Surg

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Introduction Superior capsule reconstruction (SCR) has been used for the tendon grafting of massive rotator cuff tears when primary repair is difficult. We examined the postoperative outcomes of SCR for massive rotator cuff tears and the risk factors for postoperative retear. Materials and methods Through this retrospective comparative study, we evaluated 35 patients with an average age of 75.3 (57-90) years who underwent SCR using the technique developed by Mihata et al. Clinical outcomes were evaluated 1 year postoperatively using the Japan Orthopedic Association (JOA) score, University of California Los Angeles (UCLA) shoulder score, elevation angle and the Sugaya classification, which uses a 5-point scale evaluation on magnetic resonance imaging in which types 4 and 5 are considered retears. We also investigated the progression of fatty degeneration before and after surgery and the rupture site of the graft. Acromio-humeral distance (AHD), before and after surgery was measured through X-rays. Rotator cuff tear-related shoulder arthritis was evaluated on plain X-rays using the Hamada stage. Risks of retear were identified using multiple regression analyses for sex, age, Hamada stage and JOA score. Results The JOA score improved from 62.3 ± 9.49 (SD) preoperatively to 84.6 ± 5.66 (SD) postoperatively (P < 0.001). The UCLA score improved from 15.3 ± 3.77 (SD) preoperatively to 30.1 ± 3.11 (SD) postoperatively (P < 0.001). AHD increased from 4.03 mm preoperatively to 6.23 mm postoperatively (P < 0.001). Postoperative retear was observed in seven of the 35 patients. Moreover, retear was observed in five of nine patients with a Hamada stage ≥ 4. Multiple regression analysis revealed that age ≥ 80 years, male sex and Hamada stage ≥ 4 were risk factors for retear. Conclusions While the postoperative outcomes of SCR are favorable, age, sex and degree of arthropathic change should be considered for surgical indications of SCR.

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“…In addition, the 1-year follow-up retear rate was 75% in them. 45) Some studies have suggested methods to overcome failure after massive RCT repair. Yoon et al 46) performed patch augmentation and bone marrow stimulation in 21 patients with massive RCTs and compared the results with those of conventional repair performed in 54 patients.…”

Section: Graft Augmentationmentioning

confidence: 99%

“…On the basis of conflicting outcomes documented in previous studies, the efficacy of allograft has yet to be elucidated in further research. Since differences in the composition of study population and the purpose of grafting (bridging or augmentation) affect the resultant healing rates, 45) it is of utmost importance to ensure proper patient selection. Compared to concomitant multiple channeling and augmentation, 46) the outcomes of platelet-rich plasma injection plus graft augmentation reported in recent studies have been less than satisfactory.…”

Section: Graft Augmentationmentioning

confidence: 99%

Treatment Strategy for Irreparable Rotator Cuff Tears

2018

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Recently, patients with shoulder pain have increased rapidly. Of all shoulder disorders, rotator cuff tears (RCTs) are most prevalent in the middle-aged and older adults, which is the primary reason for shoulder surgery in the population. Some authors have reported that up to 30% of total RCTs can be classified as irreparable due to the massive tear size and severe muscle atrophy. In this review article, we provide an overview of treatment methods for irreparable massive RCTs and discuss proper surgical strategies for RCTs that require operative management.

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

Cited by 44 publications

References 28 publications

Failure of Dermal Allograft Repair of Massive Rotator Cuff Tears in Magnetic Resonance Imaging and Clinical Assessment

Failure of Dermal Allograft Repair of Massive Rotator Cuff Tears in Magnetic Resonance Imaging and Clinical Assessment

Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear

Treatment Strategy for Irreparable Rotator Cuff Tears

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