Bridging the Gap in Immobile Massive Rotator Cuff Tears

Abstract

The biceps tendon interposition technique for massive rotator cuff tears offers a possible improvement in the clinical outcomes and is comparable to that of conventional repair. As well, the augmentation technique using the tenotomized biceps as potential graft for rotator cuff tears is particularly useful in bridging the gap in immobile massive rotator cuff tears with posterior defects and retraction.

Human dermal matrix scaffold augmentation for large and massive rotator cuff repairs: preliminary clinical and MRI results at 1-year follow-up

“…Synthetic scaffolds, such as mersilene meshes [8] or polytetrafluoroethylene patches [9], have been used for rotator cuff repair but, despite their excellent tensile strength, they are not recommended due to an absence of biological properties, the risk of impeding tissue tendon growth and the risk of foreign body reactions. B. Biologic scaffolds can be classified into (B1) autologous tissues from fascia lata [10], or biceps tendon [11][12][13]; (B2) homologous tissues from rotator cuff [14,15] or patellar tendon allografts, Achilles tendon allografts, and quadriceps tendon allografts [16] that were used to treat massive, irreparable rotator cuff tears and that have been associated with unsatisfactory or variable, not reproducible results; (B3) allografts or xenografts from extracellular matrices obtained through decellularization processes. This group is nowadays the most extensively studied to obtain biologic scaffolds.…”

Options Before Reverse Total Shoulder Replacement

“…Many varieties of patch materials have been developed and used clinically, including synthetic materials Polyester ligament (Dacron) [100], Gore-Tex soft tissue patch [101], Mersilene mesh [102], Teflon felt [103] and Carbon fibrebre patches [104], allografts freeze*dried rotator cuff [105,106], quadriceps tendon [107], patellar tendon, achilles tendon [107], dermal matrix (Graftjacket) [107], tensor fascia late [108] and xenografts porcine dermal collagen [109,110], porcine small intestinal submucosa [111]. Autografts such as the biceps tendon [112,113] and tensor fascia late [114] have also been used. Patch reinforcement can be performed as augmentation (onlay) of a cuff repair, in which the rotator cuff is repaired to nearly normal status and patch is then either implemented into the repair construct or sutured over the top of the repaired tendon [99].…”

Intraoperative biologische Augmentation an Sehnen und Enthesen

“…In einer anderen Studie wurden die bei der Bizepstenotomie entfernten Anteile der Sehne zur Augmentation einer massiven Rotatorenmanschettenrekonstruk tion verwendet [27]. Dabei zeigte sich sowohl in der Gruppe, bei der die Rekonstruktion arthroskopisch, sowie in der Gruppe, bei der eine offene Rekonstruktion durchgeführt wurde, eine signifikante Zunahme der Patientenzufriedenheit, des UC-LA-Scores, des CS, der Schulterbeweglichkeit, der Kraft, sowie eine korrespondierende Abnahme der Schmerzen im Vergleich zu den präoperativen Werten [27].…”

“…Dabei zeigte sich sowohl in der Gruppe, bei der die Rekonstruktion arthroskopisch, sowie in der Gruppe, bei der eine offene Rekonstruktion durchgeführt wurde, eine signifikante Zunahme der Patientenzufriedenheit, des UC-LA-Scores, des CS, der Schulterbeweglichkeit, der Kraft, sowie eine korrespondierende Abnahme der Schmerzen im Vergleich zu den präoperativen Werten [27]. Eine weitere Studie kam zu einem ähn-lichen Schluss [4].…”