Abstract
Objectives:
Structural failure of rotator cuff repair (RCR) has been reported to occur in 20-94% at one to two-year follow-up with 80% of these failures occurring within three months of surgical intervention. Poor functional outcomes as well as higher rates of retear have been reported in patients with compromised healing potential due to comorbidities such as diabetes, smoking, obesity, and hypercholesterolemia. Augmentation with growth factors and stem cells and/or biologically augmented patches has been shown to decrease re-tear rates. Biologically-augmented patches provide an environment that is conducive for cell and vessel migration. We investigated patient outcomes following RCR plus bovine bioinductive patch augmentation.
Methods:
A consecutive series of patients (2015-2018) that underwent RCR plus bovine bioinductive patch by a single surgeon were identified. Patients with diabetes, obesity, hypercholesterolemia, and smokers were included. Patients were excluded with revision rotator cuff repairs. Physical exam included shoulder ROM and manual muscle strength. Patients completed DASH, SF-12 physical and mental, VAS pain and patient satisfaction scores to assess postoperative functional outcomes. Paired sample t-tests were used to assess differences before and after surgery (p<0.05).
Results:
Sixteen patients (5 females, 62.3±14 years of age, BMI 32.3±13.7) that underwent arthroscopic RCR plus bovine bioinductive patch augmentation were included. Twelve patients had symptomatic 50-90% partial tears and four patients had full thickness tears. Average follow-up was 25.8±13.1 months. Mean shoulder flexion increased from 148.8°±17.5° to 164.7°±15.0° (p=0.0097), external rotation at 90° abduction increased from 67.8°±36.4° to 88.4°±3.5° (p=0.0316). No significant changes were seen in internal rotation behind the back (p=0.1750) or shoulder muscle strength measurements (all p>0.4471). Postoperative DASH score was 10.4±12.8, SF-12 physical score was 52.8±5, SF-12 mental score was 54.2±5.6, VAS pain score was 0.56±0.88, and patient satisfaction was 8.5±0.55. There were no complications or clinical failures at average 3-year follow-up. Patients returned to preoperative sports, including tennis, swimming, bowling, and weightlifting at an average of 21.9±14.3 weeks.
Conclusions:
RCR with bovine bioinductive patch augmentation is a good alternative treatment for patients with multiple comorbidities and partial and full thickness rotator cuff tears yielding high patient satisfaction, no loss of shoulder ROM or strength, good functional outcomes, and return to preoperative sports.