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Patch augmentation does not provide better clinical outcomes than arthroscopic rotator cuff repair for large to massive rotator cuff tears

Abstract

Purpose

Patch augmentation for large and massive rotator cuff tears (LMRCTs) has been suggested as a repair strategy that can mechanically reinforce tendons and biologically enhance healing potential. The purpose of this study was to determine whether patients who underwent patch augmentation would have lower rates of retears and superior functional outcomes.

Methods

Patients who underwent arthroscopic rotator cuff repair (ARCR) with patch augmentation (group A) were matched by age, sex, degree of retraction, and supraspinatus muscle occupation ratio to those treated with ARCR without using a patch (group B) with a minimum follow-up of 24 months. The retear (Sugaya IV or V) rates were evaluated by magnetic resonance imaging at 3 and 12 months post-surgery. The Constant– Murley Score (CMS), Korean Shoulder Score (KSS), and University of California-Los Angeles Shoulder Rating Scale (UCLA) score were retrospectively analyzed.

Results

This study included 34 patients (group A, n = 17; group B, n = 17). The mean follow-up period was 46.5 ± 17.4 months. At postoperative 1-year follow-up, group B (6 patients, 35.3%) showed higher rates of retears than group A (1 patient, 5.9%), which was statistically significant (P = 0.034). However, the postoperative CMS, KSS, and UCLA scores did not differ between the two groups at 3 months, 12 months, and the final follow-up. Additionally, the clinical outcomes of patients with retear were not significantly different from those of the healed patients in both groups.

Conclusion

The use of an allodermal patch for LMRCT is effective in preventing retears without complications. However, the clinical outcomes of ARCR using allodermal patch augmentation were not superior to those of only ARCR.

Level of evidence

III.

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Authors and Affiliations

Authors

Contributions

SC participated in the study’s design and coordination and drafted the manuscript. GK collected data and performed statistical analysis. YL also contributed to acquisition of data and building tables and figures. B-GK participated in coordination and revised the draft critically for important intellectual content. IJ contributed to statistical analysis, data collection, and revision of the manuscript. JHK conceived of the study, participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jae Hwa Kim.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

The authority granting approval: Institutional review board, CHA Bundang Medical Center, CHA University. IRB number: CHAMC2020-08-033.

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Choi, S., Kim, G., Lee, Y. et al. Patch augmentation does not provide better clinical outcomes than arthroscopic rotator cuff repair for large to massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc (2022). https://doi.org/10.1007/s00167-022-06975-8

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  • DOI: https://doi.org/10.1007/s00167-022-06975-8

Keywords

  • Rotator cuff tear
  • Massive tear
  • Rotator cuff repair
  • Matched cohort
  • Acellular dermal patch