Patch Augmentation in Rotator Cuff Repair Surgery with Elder Patients

Background: Massive rotator cuff tendon tears have a poor clinical prognosis. This holds especially true in older patients and after revision surgery. In order to reduce tears and increase long term shoulder parameters, patches made of a variety of materials have been applied to reinforce sutures in current orthopaedic practice. Material and Methods: In a clinical study on rotator cuff surgery from 2005 to 2011 (date of surgical intervention), we tested the efficacy of three different commercial patches, with 89 patients (63m/26w) enrolled with a mean age of over 60. Graft Jacket, a regenerative stable human tissue scaffold, Artelon, a slow-resorbable polyurethane-urea patch and Restore, an orthobiological degradable graft, were arthroscopically implanted in order to augment the fragile tendon-bone interface after massive tears of 2 to 3 tendons (supraspinatus and/or infraspinatus and/or subscapularis). Results: An overall repair integrity score of 75% was achieved in primary rotator cuff surgery and of 65% in revision surgery with either non- or slowly resorbable patches outperforming the degradable material. This effect is more marked after primary surgery. CS values indicate overall patient recovery at 6 months of 81.43 vs. 47.29 for Graft Jacket, 81.34 vs. 46.18 for Artelon and 78.45 vs. 41.93 for Restore. Subjective shoulder value (SSV) at 3 years increased to 9.11 vs. 4.32 for Graft Jacket, 9.31 vs. 3.53 for Artelon and 9.45 vs. 2.9 for Restore. No severe adverse affects were encountered. Conclusions: Tendons with reduced mechanical characteristics can greatly profit from patch augmentation. This holds especially true for older patients and in revision surgery. The success rate of our patch studies was up to 87% for Graft Jacket in primary rotator cuff surgery and a minimum of 58.3% for Restore in pure revision surgery (comparable studies/metastudies on massive rotator cuff tear repair success rates range from 43 to 59%). This paves the way for a continued search for better and more intelligent materials. Yield load, stiffness and ultimate load will probably improve further in the very near future.