Surgical treatment for large and massive tears of the rotator cuff

Abstract

Patients with a large or massive tear of the rotator cuff were, when possible, treated with the McLaughlin procedure. A patch graft was used when it was impossible to perform this procedure. The patch group (group P) consisted of nine patients with nine shoulders (six men, three women) with a mean age of 62.8±6.9 years. The McLaughlin group (group M) consisted of 12 patients with 12 shoulders (ten men, two women) with a mean age of 52.3±8.6 years. Mean follow-up was 2 years 11 months in group P and 4 years 2 months in group M. Using the shoulder scoring system of the Japanese Orthopaedic Association (JOA score), the total score improved post-operatively in both groups. In group P, the post-operative score was 91.7 (pre-operative score 47.9) and in group M 92.0 (pre-operative score 54.2). Tears recurred in three shoulders within 2 months of the McLaughlin procedure, and these patients were excluded from the study. The rate of 're-tearing' was lower with a patch graft (0/13) than with the McLaughlin procedure (3/17).Résumé Des malades avec une large déchirure de la coiffe des rotateurs furent traités soit par le procédé de McLaughlin quand c'était possible soit par une greffe en patch. Le groupe avec greffe (groupe P) était constitué de 9 épaules chez 9 malades (6 hommes, 3 femmes) avec un âge moyen de 62.8±6.9 années. Le groupe McLaughlin (groupe M) comportait 12 épaules chez 12 malades (10 hommes, 2 femmes) avec un âge moyen de 52.3±8.6 années. Le suivi moyen était de 35 mois dans le groupe P, et 50 mois dans le groupe M. En utilisant le système de cotation de l'épaule de l'Association Orthopédique Japonaise (JOA score), le score total a été amélioré en postopéra-toire dans les deux groupes. Dans le groupe P le score postopératoire était 91.7 ( 47.9 avant l'opération) et dans le groupe M le score postopératoire était 92.0 ( 54.2 avant l'opération). Les déchirures ont récidivés dans 3 épaules dans les 2 mois suivant le procédé de McLaughlin et ces malades a été exclus de l'étude. Le taux de récidive était plus faible avec une greffe en patch (0/13) qu'avec la méthode de McLaughlin (3/17).

Bilateral rotator cuff repair utilizing augmentation nine patch grafts over 24 years in one patient with polio paraplegia: A case report

“…Ito and Morioka in their study in 2003, [14] also commented that decreased re-tearing noted on the McLaughlin patch graft group compared to the regular McLaughlin group may be in part due to decreased tension allowed by the patch graft re-enforcement of the primary cuff repair. [14] Comment The senior author continues to use patch grafts in both frail tissue repairs as well as large cuff defects in paraplegic and non-paraplegic patients. The current graft of choice is a dermal allograft (see Figures 2 and 3).…”

Bilateral rotator cuff repair utilizing augmentation nine patch grafts over 24 years in one patient with polio paraplegia: A case report

“…Bond et al [13] found 13 of 16 patients had MRI confirmed integration and overall patient satisfaction with the augmentation of irreparable RC tears with GraftJacket Allograft with 2 year average follow-up. One Japanese study by Ito and Morioka [14] compared the McLaughlin procedure alone (n = 12) to repair using a double layer allograft patch (n = 9). The McLaughlin procedure described in that article begins with a deltoid split and is essentially a trans-osseous non-tension repair of deficient cuff which clears the articular surface of the humeral head into a trough cut into the medial aspect of the GT just lateral to the humeral head articular surface.…”

Options Before Reverse Total Shoulder Replacement

“…In an attempt to decrease the failure rate and improve the outcomes of massive cuff tears repair, the use of patch grafts was introduced and popularized by various authors. 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.…”