The Journal of the American Academy of Orthopaedic Surgeons · 2022
Follow-up on a Biological Revision Technique for Large, Recurrent, Retracted, Rotator Cuff Tears.
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Skoff Hillel
Аннотация
INTRODUCTION: Revision of large recurrent rotator cuff tears by simple repair has a structural failure rate of 40% to 90%. The author presents a minimum 2-year follow-up study of revision rotator cuff reconstructions using a bridging patch graft composed of autogenous biceps tendon saturated with concentrated autologous iliac bone marrow, to determine how the technique compares to the reported outcome of simple repair as a treatment alternative.
METHODS: The principal entrance criterion was a symptomatic rotator cuff retear with retraction creating a 3- to 5-cm defect. Twenty-five consecutive patients (with an average age of 62 years) were enrolled. Twenty-two (88%) were available for follow-up at 24 to 120 months (mean 68 months) for interview and examination. Questionnaires using Constant, American Shoulder and Elbow Surgeons, and University of California at Los Angeles (UCLA) Shoulder scores were completed. In the terminal 15 patients, the presence of viable marrow mesenchymal cells fixed to the tendon graft at the time of implantation was determined by histological verification. Rotator cuff integrity was evaluated by ultrasonography examination. The Wilcoxon rank-sum test was used to compare nonparametric preoperative with postoperative questionnaire outcome scores.
RESULTS: Twenty of 22 patients (91%) demonstrated an intact tendon construct. Two of 22 patients (9%) demonstrated structural failure. Viable mesenchymal cells were identified on all graft specimens in high concentration. All patients showed improved results: The mean Constant score increased from 13 to 76; American Shoulder and Elbow Surgeons from 17 to 81; UCLA from 6 to 29 (P < 0.001).
DISCUSSION: The autogenous graft/marrow technique consistently and successfully reconstructed a large, recurrent rotator cuff tear in a clinical setting where the primary cuff repair had failed. The observation that an autogenous tendon graft saturated with concentrated marrow has the biological potential to reconstruct a difficult soft-tissue defect in the shoulder strongly implies its potential as a reconstructive tool for other soft-tissue defects.
METHODS: The principal entrance criterion was a symptomatic rotator cuff retear with retraction creating a 3- to 5-cm defect. Twenty-five consecutive patients (with an average age of 62 years) were enrolled. Twenty-two (88%) were available for follow-up at 24 to 120 months (mean 68 months) for interview and examination. Questionnaires using Constant, American Shoulder and Elbow Surgeons, and University of California at Los Angeles (UCLA) Shoulder scores were completed. In the terminal 15 patients, the presence of viable marrow mesenchymal cells fixed to the tendon graft at the time of implantation was determined by histological verification. Rotator cuff integrity was evaluated by ultrasonography examination. The Wilcoxon rank-sum test was used to compare nonparametric preoperative with postoperative questionnaire outcome scores.
RESULTS: Twenty of 22 patients (91%) demonstrated an intact tendon construct. Two of 22 patients (9%) demonstrated structural failure. Viable mesenchymal cells were identified on all graft specimens in high concentration. All patients showed improved results: The mean Constant score increased from 13 to 76; American Shoulder and Elbow Surgeons from 17 to 81; UCLA from 6 to 29 (P < 0.001).
DISCUSSION: The autogenous graft/marrow technique consistently and successfully reconstructed a large, recurrent rotator cuff tear in a clinical setting where the primary cuff repair had failed. The observation that an autogenous tendon graft saturated with concentrated marrow has the biological potential to reconstruct a difficult soft-tissue defect in the shoulder strongly implies its potential as a reconstructive tool for other soft-tissue defects.