Clinical Outcomes following Biologically Enhanced Demineralized Bone Matrix Augmentation of Complex Rotator Cuff Repair

Abstract

Complex rotator cuff tears provide a significant challenge for treating surgeons, given their high failure rate following repair and the associated morbidity. The purpose of this study is to evaluate the clinical outcomes of patients who underwent biologically enhanced demineralized bone matrix augmentation of rotator cuff repairs. Twenty patients with complex rotator cuff tears underwent arthroscopic rotator cuff repair by a single surgeon with demineralized bone matrix (DBM) augmentation that was biologically enhanced with platelet-rich plasma and concentrated bone marrow aspirate. Post-operative MRI was used to determine surgical success. Patient reported outcome measures and range of motion data were collected pre-operatively and at the final post-operative visit for each patient. Ten patients (50%) with DBM augmentation of their arthroscopic rotator cuff repair were deemed non-failures. The failure group had less improvement of visual analogue pain scale (p = 0.017), Simple Shoulder Test (p = 0.032), Single Assessment Numerical Evaluation (p = 0.006) and abduction (p = 0.046). There was no difference between the groups for change in American Shoulder and Elbow Society score (p = 0.096), Constant-Murley score (p = 0.086), forward elevation (p = 0.191) or external rotation (p = 0.333). The present study found that 50% of patients who underwent biologically enhanced DBM augmentation of their rotator cuff repair demonstrated MRI-determined failure of supraspinatus healing.

Aktuelle Aspekte der Behandlung der Rotatorenmanschette

“…Sie berichten über Kombinationen von dermalen Allografts mit subakromialer Bursa, platelet-rich plasma (PRP) und platelet-poor plasma (PPP), konzentriertem Knochenmarkaspirat, und autologem Thrombin. Bisher konnte noch kein substanzieller klinischer Benefit dieser Verfahren gezeigt werden [6,52,78].…”

Advancements in Sports Medicine

“…Li et al conducted a review of the current literature and reported that bone quality, insertion depth, insertion angle, size of rotator cuff tear, preoperative corticosteroid injections, anchor design, and the materials used to produce anchors may influence the anchor pullout strength, leading to a poor recovery [1]. Regarding massive rotator cuff tear that cannot be fixed directly, Wellington et al used a biologically enhanced demineralized bone matrix for the augmentation and found that 10 of 20 patients who received this treatment still suffered from a retear at follow-up [2]. This outcome suggested that there is still a long way to go to enhance the repair of rotator cuff.…”