Massive rotator cuff tear treated with a synthetic patch: a case report 16 years after surgery

Abstract

Massive rotator cuff tears usually cannot be repaired due to tendon atrophy and marked retraction, as well as muscles fatty degeneration. There are several options for surgical treatment: open or arthroscopic debridement with or without subacromial decompression, arthroscopic isolated biceps tenotomy, partial tendon repair, use of synthetic or biologic patches, tendon transfers, hemiarthroplasty, reverse arthroplasty, and arthrodesis. In this article, we will discuss a particular case of massive rotator cuff tear treated with Marlex mesh. The patient was clinically, radiologically, and MRI checked 16 years after the surgical implant. The active function of shoulder had preserved very well, the Constant score was 76. The X-rays showed a limited progression of osteoarthritis without further cranial migration of the humeral head. At MR cartilage preservation was appreciated, the patch being in good position and the teres minor being smaller than average but it was nonetheless present. This case report can highlight the usefulness of patches in patients with irreparable rotator cuff lesion both for the immediate benefit in terms of pain, strength, movement, and in perspective allowing for the preservation of anatomical structures that might avoid the need for a prosthetic implant over the years.

Morphologic Changes of Synthetic (ePTFE) Interpositional Patch Repair for Massive Irreparable Rotator Cuff Tear

“…The above subjective and objective findings of pain relief and improved function in all patients were consistent with previous studies by us 21,26 and others 8,10,[12][13][14][15]17,27 evaluating synthetic interpositional patch grafts. Relief of shoulder pain after interpositional synthetic patch grafting has been attributed by others 10,17,27 to subacromial decompression and acromioplasty before application of the patch.…”

“…Complete bone bonding of a synthetic patch (Gore-Tex expanded PTFE patch; WL Gore & Associates Inc., Flagstaff, AZ) to the greater tuberosity footprint has been observed during reoperation of retears in 3 patients. 8,[10][11][12][13][14]16,17 To our knowledge, monitoring of the changes of the host tissue attachments such as the native tendon to patch and patch to bony landing site in the early stages of healing with the use of synthetic patches has not been investigated. 8,10-17 Nada et al 13 evaluated tendon fatty degeneration changes after the use of a Dacron (Xiros, Leeds, UK) synthetic rotator cuff bridge, showing an overall 1 grade improvement in fatty degeneration in the supraspinatus of 5 patients (5/15), whereas fatty degeneration remain largely unchanged with the infraspinatus (11/15) and the subscapularis (14/15).…”

Management of complications after rotator cuff surgery

“…One example of this is scaffolds that are designed to augment or bridge the muscletendon-bone unit and eventually incorporate into the host tissue. There are a variety of recent reports of utilizing synthetic scaffolds, biologic scaffolds, treated allograft/xenograft tissue, or autograft tissue to augment rotator cuff repairs [99][100][101][102][103][104][105][106][107]. However, many of these reports consist of technique articles or have short-term follow-up with no control group.…”

Arthroscopic Partial Repair of Irreparable, Massive Rotator Cuff Tears

“…Interestingly, the latter can still be performed to treat failed arthroscopic partial cuff repair. As further procedural alternatives, both patch-augmented rotator cuff repair 7 and arthroscopic superior capsule reconstruction 8 have recently been described. Again, the lack of long-term results for these techniques and the consequent concerns about prognoses should be considered.…”