Irreparable Large to Massive Rotator Cuff Tears With Low-Grade Fatty Degeneration of the Infraspinatus Tendon: Minimum 7-Year Follow-up of Fascia Autograft Patch Procedure and Partial Repair
Restricted accessResearch articleFirst published online November, 2021
Irreparable Large to Massive Rotator Cuff Tears With Low-Grade Fatty Degeneration of the Infraspinatus Tendon: Minimum 7-Year Follow-up of Fascia Autograft Patch Procedure and Partial Repair
In shoulders with irreparable massive rotator cuff tears (RCTs) with high-grade fatty degeneration (Goutallier stage 3 or 4) of the supraspinatus tendon and low-grade fatty degeneration (Goutallier stage 1 or 2) of the infraspinatus tendon (ISP), arthroscopic patch grafting (PG) has been reported as superior to partial repair (PR) regarding the ISP retear rate at short-term to midterm follow-up. However, the longer term outcomes are unclear.
Purpose:
To compare clinical and structural outcomes in the PG and PR groups at a minimum of 7 years postoperatively.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
We evaluated 24 patients in the PG group and 24 patients in the PR group. We primarily used the Constant score for clinical outcomes and performed magnetic resonance imaging for structural outcomes in the PG and PR groups. The risk factors for a retear of the ISP were identified by univariate and multivariate (forward stepwise selection method) logistic regression analyses. We primarily compared values at midterm follow-up (<4 years) with values at the final follow-up (minimum 7 years) for each patient.
Results:
The mean midterm and final follow-up times for the PG group were 41.0 and 95.1 months, respectively, compared with 35.7 and 99.3 months, respectively, for the PR group. We found significant differences for the midterm and final follow-up Constant total scores in the PG and PR groups (midterm follow-up: 79.1 vs 69.9, respectively [P = .001]; final follow-up: 76.0 vs 65.3, respectively [P = .006]) and in the Constant strength scores (midterm follow-up: 14.6 vs 8.5, respectively [P < .001]; final follow-up: 13.1 vs 8.3, respectively [P = .001]). Treatment group (PR) was a significant predictor of an ISP retear in the logistic regression analysis (odds ratio, 3.545; P = .043).
Conclusion:
Patients with low-grade massive RCTs treated with PG or PR improved significantly in terms of clinical outcomes at the midterm and final follow-up time points. However, Constant scores were significantly better in the PG group at the final follow-up.
AzevedoCICCatarinaLeiria Pires Gago Ângelo ACampos-CorreiaDDelgadoLFerreiraNSevivasN. Clinical importance of graft integrity in arthroscopic superior capsular reconstruction using a minimally invasively harvested midthigh fascia lata autograft: 3-year clinical and magnetic resonance imaging outcomes. Am J Sports Med. 2020;48(9):2115-2128.
2.
BarberFABurnsJPDeutschALabbéMRLitchfieldRB. A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthroscopy. 2012;28(1):8-15.
3.
BediADinesJWarrenRFDinesDM. Massive tears of the rotator cuff. J Bone Joint Surg Am. 2010;92(9):1894-1908.
4.
BerthANeumanWAwiszusFPapG. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. J Orthop Traumatol. 2010;11:13-20.
5.
BondJLDopirakRMHigginsJBurnsJSnyderSJ. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy. 2008;24(4):403-409.
6.
BurkhartSSBarthJRRichardsDPZlatkinMBLarsenM. Arthroscopic repair of massive, irreparabale rotator cuff tears with stage 3 and 4 fatty degeneration. Arthroscopy. 2007;23(4):347-354.
7.
BurkhartSSHartzlerRU. Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis. Arthroscopy. 2019; 35(1):22-28.
BurnierMElhassanBTSanchez-SoteloJ. Surgical management of irreparable rotator cuff tears: what works, what does not, and what is coming. J Bone Joint Surg Am. 2019;101(17):1603-1612.
10.
ChenKHChiangERWangHYMaHL. Arthroscopic partial repair of irreparable rotator cuff tears: factors related to greater degree of clinical improvement at 2 years of follow-up. Arthroscopy. 2017;33(11): 1949-1955.
11.
CiampiPScottiCNonisA, et al. The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow- up study. Am J Sports Med. 2014;42(5):1169-1175.
12.
CofieldRHPaviziJHoffmeyerPJLanzerWLIIstrupDMRowlandCM. Surgical repair of chronic rotator cuff tears: a prospective long-term study. J Bone Joint Surg Am. 2001;83(1):71-77.
13.
CuffDJPupelloDRSantoniBG. Partial rotator cuff repair and biceps tenotomy for the treatment of patients with massive cuff tears and retained overhead elevation: midterm outcome with a minimum 5 years of follow-up. J Shoulder Elbow Surg. 2016;25(11):1803-1809.
14.
CvetanovichGLGowdAKLiuJN, et al. Establishing clinically significant outcome after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2019;28:939-948.
15.
FuchsBWeishauptDZanettiMHodlerJGerberC. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg. 1999;8:599-605.
16.
GalassoORiccelliDADe GoriM, et al. Quality of life and functional results of arthroscopic partial repair of irreparable rotator cuff tears. Arthroscopy. 2017;33(2):261-268.
17.
GerberCMaquieriaGEspinosaN. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am. 2006;88(1):113-120.
18.
GilotGJAlvarez-PinzonAMBarcksdaleLWesterdahlDKrillMPeckE. Outcome of large to massive rotator cuff tears repaired with and without extracellular matrix augmentation: a prospective comparative study. Arthroscopy. 2015;31(8):1459-1465.
19.
GladstoneJNBishopJYLoIKFlatowEL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med. 2007;35(5):719-728.
20.
GoutallierDPostelJMBernageauJLavauLVoisinMC. Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78-83.
21.
GoutallierDPostelJMGleyzePLeguillouxPVan DriesscheS. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003;12(6):550-554.
22.
GuptaAKHugKBerkoffDJ, et al. Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Med. 2012;40(1):141-147.
23.
GusmerPBPotterHGDonovanWDO’BrienSJ. MR imaging of the shoulder after rotator cuff repair. AJR AM J Roentgenol. 1997; 168(2):559-563.
24.
HamadaKYamanakaKUchiyamaYMikasaTMikasaM. A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res. 2011;469(9):2452-2460.
25.
IannottiJPCodsiMJKwonYWDerwinKCicconeJBremsJJ. Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears: a randomized, controlled trial. J Bone Joint Surg Am. 2006;88(6):1238-1244.
26.
KimHMCaldwellJMBuzaJA, et al. Factors affecting satisfaction and shoulder function in patients with a recurrent rotator cuff tear. J Bone Joint Surg Am. 2014;96(2):106-112.
27.
KimSJKimSHLeeSKSeoJWChunYM. Arthroscopic repair of massive contracted rotator cuff tears: aggressive release with anterior and posterior interval slide do not improve cuff healing and integrity. J Bone Joint Surg Am. 2013;95(16):1482-1488.
28.
KohKHLimTKParkYELeeSWParkWHYooJC. Preoperative factors affecting footprint coverage in rotator cuff repair. Am J Sports Med. 2014;42(4):869-874.
29.
KukkonenJKaukoTVahlbergTJoukainenAAärimaaV. Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg. 2013;22(12):1650-1655.
30.
KuzelBRGrindelSPapandreaRZieglerD. Fatty infiltration and rotator cuff atrophy. J Am Acad Orthop Surg. 2013;21(10):613-623.
31.
LewingtonMRFergusonDPSmithDBurksRCoadyC. Graft utilization in the bridging reconstruction of irreparable rotator cuff tears: a systematic review. Am J Sports Med. 2017;45(13):3149-3157.
32.
LinJSunYChenQLiuSDingZChenJ. Outcome comparison of graft bridging and superior capsule reconstruction for large to massive rotator cuff tears: a systematic review. Am J Sports Med. 2020;48(11):2828-2838.
33.
LiuJHughesREO’DriscollSWAnKN. Biomechanical effect of medial advancement of the supraspinatus tendon: a study in cadavera. J Bone Joint Surg Am. 1998;80(6):853-859.
34.
MelisBWallBWalchG. Natural history of infraspinatus fatty infiltration in rotator cuff tears. J Shoulder Elbow Surg. 2010;19(5):757-763.
35.
MihataTLeeTQWatanabeC, et al. Clinical results of superior capsular reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29(3):459-470.
36.
MochizukiTSugayaHUomizuM, et al. Humeral insertion of the supraspinatus and infraspinatus: new anatomic findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am. 2008;90(5):962-969.
37.
MoriDFunakoshiNYamashitaF. Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade fatty degeneration of the infraspinatus: patch autograft procedure versus partial repair procedure. Arthroscopy. 2013;29(12):1911-1921.
38.
MoriDFunakoshiNYamashitaFWakabayashiT. Effect of fatty degeneration of the infraspinatus on the efficacy of arthroscopic patch autograft procedure for large to massive rotator cuff tears. Am J Sports Med. 2015;43(5):1108-1117.
39.
OizumiNSuenagaNFukudaKMinamiA. Massive rotator cuff tears repaired on top of head by McLaughlin’s procedure. J Shoulder Elbow Surg. 2007;16(3):321-326.
40.
OnoYHerreraDADWoodmassJMBoormanRSThorntonGMLoIK. Can graft provide superior tendon healing and clinical outcomes after rotator cuff repairs? A meta-analysis. Orthop J Sports Med. 2016;4(12):2325967116674191.
41.
OnoYHerreraDADWoodmassJMBoormanRSThorntonGMLoIK. Graft augmentation versus bridging for large to massive rotator cuff tears: a systematic review. Arthroscopy. 2017;33(3):673-680.
42.
OnoYHerreraDADWoodmassJMBoormanRSThorntonGMLoIK. Healing rate and clinical outcomes of xenografts appear to be inferior when compared with other graft in rotator cuff repair: a meta-analysis. J ISAKOS. 2016;1:321-328.
43.
OwenRSIannottiJPKneelandJBDalinkaMKDerenJAOleagaL. Shoulder after surgery: MR imaging with surgical validation. Radiology. 1993;186(2):443-447.
44.
PorcelliniGCastagnaACesariEMerollaGPellegriniAPaladiniP. Partial repair of irreparable supraspinatus tendon tears: clinical and radiographic evaluations at long-term follow-up. J Shoulder Elbow Surg. 2011;20(7):1170-1177.
45.
RulewiczGJBeatySHawkinsRJKissenberthMJ. Supraspinatus atrophy as a predictor of rotator cuff tear size: an MRI study utilizing the tangent sign. J Shoulder Elbow Surg. 2013;22(6):e6-e10.
46.
ShonMSKohKHLimTKKimWJKimKCYooJC. Arthroscopic partial repair of irreparable rotator cuff tears: preoperative factors associated with outcome deterioration over 2 years. Am J Sports Med. 2015;43(8):1965-1975.
47.
SugayaHMaedaKMatsukiKMoriishiJ. Repair integrity and functional outcome after rotator cuff repair: a prospective outcome study. J Bone Joint Surg Am. 2007;89(5):953-960.
48.
TashjianRZShinJBroschninskyK, et al. Minimal clinically important difference in the American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale pain scores after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2020; 29:1406-1411.
49.
ThomazeauHBoukobzaEMorcetNChapersonJLanglaisF. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997;344:275-283.
50.
VisotskyJLBassamaniaCSeebauerLRockwoodCAJensenKL. Cuff tear arthropathy: pathogenesis, classification and algorithm for treatment. J Bone Joint Surg Am. 2004;86(2):35-40.
51.
VitaliMCusumanoAPedrettiANaim RodriguezNFraschiniG. Employment of synthetic patch with augmentation of the long head of the biceps tendon in irreparable lesions of the rotator cuff: our technique applied to 60 patients. Tech Hand Up Extrem Surg. 2015;19(1):32-39.
52.
WalchGBoulahiaACalderoneSRobinsonAH. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator cuff tears. J Bone Joint Surg Br. 1998;80(4):624-628.
53.
WilliamsMDLädermannAMelisBBarthelemyRWalchG. Fatty infiltration of the supraspinatus: a reliability test. J Shoulder Elbow Surg. 2009;18(4):581-587.
54.
YamamotoNItoiETuohetiY, et al. Glenohumeral joint motion after medial shift of the attachment site of the supraspinatus tendon: a cadaveric study. J Shoulder Elbow Surg. 2007;16(3):373-378.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
