THE TREATMENT OF MASSIVE ROTATOR CUFF TEARS WITH TWO DIFFERENT PATCHES

Summary Statement In this study, massive rotator cuff tears were treated using an absorbable collagen-based patch or a non-absorbable synthetic patch. Results demonstrated the efficacy of the use of the synthetic prolene patch especially for elderly patients Introduction The treatment of massive rotator cuff tears presents a challenging problem in shoulder surgery. Traditional repair techniques are associated with high rupture rates due to excessive tension on the repair and the presence of degenerated tendon tissue. These factors have led to attempts to reconstruct the rotator cuff with grafts, using synthetic materials or biologic tissues. The purpose of this study was to compare the efficacy of the use of pericardium patch with the use of prolene patch in the repair of extensive rotator cuff tears. Materials & Methods A retrospective series of 180 patients, 115 men and 65 women with a mean age of 66.8 years treated for a massive rotator cuff tear from 1997 to 2008 is reported. The inclusion criteria were: patients symptomatic with pain, deficit of elevation, not responsive to the physiotherapy, tear size (massive: 2 or more tendons), minimum follow-up of 2 years since surgery, active and motivated patients. Patients were divided into three groups according to the type of treatment received: group 1 was treated with Pericardium patch, group 2 with Prolene patch, group 3 with simple suture. All groups were homogeneous. Plain radiographs, ultrasound and MRI were performed preoperatively and at 3 years. Patients were clinically evaluated using the UCLA score before surgery and at 2 months and 3 years after surgery (mean follow-up 2, 6 years). Pain was assessed by use of VAS scale, strength by the use of dynamometer. The surgical procedure (mini-open technique) was similar in all groups. Statistical analysis was conducted by one-way ANOVA between groups of treatment with Dunnett9s C post-hoc correction for multiple comparisons. P-values of 0.05 or less were considered as statistically significant. Results After 2 months the mean VAS was 6.85±1.11, 6.45±1.01, 4.9±0.9 while the mean UCLA was 11.28±1.43, 13.35±14.21, 20.85±12.77, respectively for Control, Collagen and Prolene group. After 36 months the mean VAS was 3.7±1.01, 4.05±0.98, 3.23±1.07, while the mean UCLA was 14.73±1.96, 14.86±2.08, 24.6±3.3 respectively for Control, Collagen and Prolene group. In addition, after 36 months elevation on the scapular plane was 140.75°±10.48, 141.58°±11.87, 174.75°±8.1 and abduction strength was 8.57kg±0.63, 8.82kg±0.7, 13.61kg±0.84, respectively for Control, Collagen and Prolene group. Retear rate after 12 months was 40% (24/60) for Control group, 48.33% (29/60) for Collagen group, 15% (9/60) for Prolene group. Conclusion The use of Prolene patch as an augmentation graft in the treatment of massive rotator cuff tears is safe and, in most patients, can give a significant pain relief and improvement of range of motion and strength with few complications.