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Beitragstitel Massive Rotator Cuff Tears With Short Tendon Length Can Be Successfully Repaired Using Synthetic Patch Augmentation
Beitragscode P02
Autoren
  1. Adrian Chlasta Vortragender
  2. Lukas Dommer Sonnenhof - Bern
  3. Tomás Rojas
  4. Annabel Hayoz Orthopädie Sonnenhof
  5. Michael Schär Inselspital Bern, Universität Bern
  6. Matthias A. Zumstein Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland
Präsentationsform Poster
Themengebiete
  • A01 - Schulter/Ellbogen
Abstract Introduction
Choosing the optimal treatment for massive rotator cuff tears (MRCT) still poses a surgical problem. In MRCT with good muscle quality, but short tendon length, non-augmented repairs lead to high failure rates of up to 90%.
The aim of the study was to evaluate clinical and radiological outcomes of MRCT without clinical pseudoparalysis and good muscle quality, but short tendon length, which were repaired at the medial footprint with synthetic patch augmentation with a minimum follow-up of two years.

Methods
Arthroscopic or open rotator cuff repairs, with patch augmentation, were performed on fourteen patients between 2016 and 2019, who presented MRCT confirmed by an MR arthrogram showing good muscle quality (Goutallier ≤ 2) and short tendon length (length < 15 mm).
Constant-Murley score (CS), subjective shoulder value (SSV) and range of motion were compared pre-operatively and at least two years post-operatively. Clinical failures were defined by re-operation, forward flexion < 120 or a relative CS < 70. Structural integrity of the repair was assessed by MRI. Comparison between different variables and outcomes was performed using Wilcoxon-Mann-Whitney and Chi square tests.

Results
Fourteen patients (mean age 57 years, 12 (86%) male, 8 (57%) right shoulders) were reevaluated with a mean follow up of 46 months (28-59 months). There was a significant improvement in the absolute CS (from 35 to 84 points, p=0.003), the relative CS (from 39% to 94%, p=0,001), the SSV (from 34% to 90%, p=0.003) and forward flexion (from 115° to 168°, p=0.003) but not in external rotation (from 34° to 39°, p=0.34).
There were three clinical failures with a re-operation, two conversions to a reverse total shoulder arthroplasty, one underwent a patch augmented re-repair. Structurally, there were six failures (two partial; four full-thickness re-tears) of which only one re-tear size exceeded 10 mm.
The presence of a full-thickness or partial re-tear was not associated with inferior clinical outcomes compared to intact cuff repairs. There were no correlations between the grade of retraction, muscle quality or rotator cuff tear configuration and re-rupture or functional outcomes.

Conclusion
Patch augmented cuff repair for MRCT with good muscle quality, but short tendon length and high retraction grades leads to a significant improvement in functional outcomes with low full-thickness re-tear rates and reoperations.