August 7, 2019
Rotator cuff tears are a leading cause of shoulder pain. The larger the tear, the more difficult the operation to fix the tear and the higher the re-tear rate. In addition to tear size, there are many biologic and mechanical factors that come into play in determining whether a rotator cuff tear will ultimately go on to heal with surgery.
Research into new methods to increase the healing rate of rotator cuff tears is actively underway. One surgical technique is to use additional material—either tissue take from another part of the body, a sterilized cadaver tissue, tissue from a different species, or even a synthetic fabric—to help strengthen the repair by acting as a patch to augment the repaired tendon or as an interposition to bridge contracted rotator cuff tissue which cannot reach to bone. These materials have been shown to provide both mechanical strength to the repair and augment the biology by providing a scaffold for healing cells to incorporate into.
In this study, Dr. Grant Garrigues, a shoulder and elbow surgeon at Midwest Orthopaedics at Rush, led a team of researchers to review every peer-reviewed study that has been published utilizing this technology for rotator cuff repair with a minimum of one year of follow-up and that included at least 10 patients. After going through 774 papers revealed by the initial search, 36 relevant articles were included with 1291 shoulders were analyzed. This systematic process allowed the results of the quality studies to be pooled to look at overarching themes.
The results, presented in a recent issue of the American Journal of Sports Medicine showed that outcomes improved whether shoulders were treated with repair alone or the repair was strengthened with additional material. However, interestingly, this study found that fewer patients re-tore their rotator cuff when they were treated with matrix augmentation or interposition graft than those who were not. In addition, on post-operative surveys, patients reported being able to do more activities of daily life more easily when treated with a patch or bridge than who were not.
Rotator cuff tears are a common cause of shoulder pain that can be disabling. Large and massive tears have a high re-tear rate. Dr. Garrigues and colleagues have shown that using matrix augmentation and interposition grafting reduces the re-tear rate and can lead to better clinical outcomes.