Treatment of massive rotator-cuff tears with a polyester ligament (Dacron) augmentation

Abstract

We describe the clinical outcome of a technique of surgical augmentation of chronic massive tears of the rotator cuff using a polyester ligament (Dacron) in 21 symptomatic patients (14 men, seven women) with a mean age of 66.5 years (55.0 to 85.0). All patients had MRI and arthroscopic evidence of chronic massive tears. The clinical outcome was assessed using the Constant and Murley and patient satisfaction scores at a mean follow-up of 36 months (30 to 46). The polyester ligament (500 mm × 10 mm) was passed into the joint via the portal of Neviaser, medial to the tear through healthy cuff. The two ends of the ligament holding the cuff were passed through tunnels made in the proximal humerus at the footprint of the insertion of the cuff. The ligament was tied with a triple knot over the humeral cortex. All the patients remained free from pain (p < 0.001) with improvement in function (p < 0.001) and range of movement (p < 0.001). The mean pre-operative and post-operative Constant scores were 46.7 (39.0 to 61.0) and 85.4 (52.0 to 96.0), respectively (p < 0.001). The mean patient satisfaction score was 90%. There were two failures, one due to a ruptured ligament after one year and the other due to deep-seated infection. The MR scan at the final follow-up confirmed intact and thickened bands in 15 of 17 patients. This technique of augmentation gives consistent relief from pain with improved shoulder movement in patients with symptomatic massive tears of the rotator cuff.

Tendon injury and repair – A perspective on the basic mechanisms of tendon disease and future clinical therapy

“…polyester [247][248][249][250][251], polypropylene [252,253], polyethelene(-terephthalate) [254][255][256][257][258] and carbon [259,260]. Despite the success reported for these non-degradable scaffold materials, the high mechanical demands on a tendon (or ligament) graft have not resulted in long-term, functional repair [187].…”

Patch Augmentation for Massive Rotator Cuff Tears

“…28) And the fact that many studies do not include control groups makes it difficult to conduct comparative analyses (Table 2). 17,19,[29][30][31][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] Studies that compare outcomes of graft augmentation with those of other control surgical techniques, such as the conventional repair technique, are summarized in Table 3. 27,28,32,46,[48][49][50] In almost all studies, whichever graft was used, clinical parameters, such as range of motion, the American Shoulder and Elbow Surgeons Evaluation Form (ASES) score, the University of California-Los Angeles (UCLA) score, and the Constant score significantly improved with patch augmentation.…”

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.…”