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Surgical Management of Massive Irreparable Cuff Tears/Management of Rotator Cuff Disease: Interpositional Graft for Irreparable Posterosuperior Rotator Cuff Tears

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Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Increasingly, massive irreparable rotator cuff tears present a treatment challenge due to their high re-tear rates. The reparability of such tears depends on factors like tear size, the number of involved tendons, tendon retraction extent, muscular atrophy, fatty infiltration, and the presence or absence of arthritis. There are non-surgical and several surgical treatment options described each with their specific indications, contraindications, pros, and cons. Bridging reconstruction restores the superior rotator cuff tissue and arrests humeral head superior migration. The purpose of his review is to explore the existing literature on interpositional graft mechanics, indications, surgical technique, and clinical outcomes. It aims to understand how these parameters can facilitate the incorporation of bridging reconstruction using interpositional grafts into a surgeon’s practice for managing massive irreparable rotator cuff tears.

Recent Findings

Interpositional grafts for irreparable massive rotator cuff tears can either be auto-, allo-, xenografts, or synthetic material and are best suited for patients who are relatively younger, no glenohumeral arthritis, and minimal to no fatty infiltration and muscle atrophy. Short to medium term outcome studies available report good functional, clinical, and radiological improvements with bridging reconstruction utilizing acellular dermal matrix allograft.

Summary

Interpositional grafts for management of irreparable posterosuperior cuff tears provides improved clinical and radiological outcomes with minimal complications and thus a viable and valuable surgical technique for a shoulder surgeon’s armamentarium.

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Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. JBJS. 1984;66(4):563–7.

    Article  CAS  Google Scholar 

  2. Cofield RH. Rotator cuff disease of the shoulder. JBJS. 1985;67(6):974–9.

    Article  CAS  Google Scholar 

  3. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. JBJS. 2000;82(4):505–15.

    Article  CAS  Google Scholar 

  4. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.

    Article  Google Scholar 

  5. Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res. 1990;254:81–6.

    Article  Google Scholar 

  6. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res. 1990;254:92–6.

    Article  Google Scholar 

  7. Mercurio M, Castricini R, Castioni D, Cofano E, Familiari F, Gasparini G, et al. Better functional outcomes and a lower infection rate can be expected after superior capsular reconstruction in comparison with latissimus dorsi tendon transfer for massive, irreparable posterosuperior rotator cuff tears: a systematic review. J Shoulder Elb Surg. 2023;32(4):892–906.

    Article  Google Scholar 

  8. Lädermann A, Denard PJ, Collin P. Massive rotator cuff tears: definition and treatment. Int Orthop. 2015;39(12):2403–14.

    Article  PubMed  Google Scholar 

  9. Wong I, Burns J, Snyder S. Arthroscopic GraftJacket repair of rotator cuff tears. J Shoulder Elb Surg. 2010;19(2 SUPPL.):104–9.

    Article  Google Scholar 

  10. Koh J, Zaffagnini S, Kuroda R, Longo UG, Amirouche F. Orthopaedic biomechanics in sports medicine. Orthop Biomech Sports Med. 2021: 1–438.

  11. Sheth MM, Shah AA. Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts. Orthop J Sports Med. 2023;11:1–12.

    Google Scholar 

  12. Burkhart SS, Esch JC, Jolson RS. The rotator crescent and rotator cable: An anatomic description of the shoulder’s “suspension bridge.” Arthroscopy. 1993;9(6):611–6.

    Article  CAS  PubMed  Google Scholar 

  13. •• Awad MA, Sparavalo S, Ma J, King JP, Wong I. Interposition Graft Bridging Reconstruction of Irreparable Rotator Cuff Tears Using Acellular Dermal Matrix: Medium-Term Results. Arthrosc - J Arthrosc Relat Surg. 2022;38(3):692–8 Very Important- first published medium term results on clinical and radiological outcomes of bridging reconstruction.

    Article  Google Scholar 

  14. Lewington MR, Ferguson DP, Smith TD, Burks R, Coady C, Wong IHB. Graft Utilization in the Bridging Reconstruction of Irreparable Rotator Cuff Tears: A Systematic Review. Am J Sports Med. 2017;45(13):3149–57.

    Article  PubMed  Google Scholar 

  15. Gulotta LV, Craig EV. Massive rotator cuff tears: Diagnosis and management. Massive Rotator Cuff Tears: Diagnosis Manag. 2015: 1–163.

  16. Jones CR, Snyder SJ. Massive Irreparable Rotator Cuff Tears: A Solution That Bridges the Gap. Sports Med Arthroscopy Rev. 2015;23:130–8.

    Article  CAS  Google Scholar 

  17. Hirahara AM, Andersen WJ, Panero AJ. Ultrasound Assessment of the Superior Capsular Reconstruction With Dermal Allograft: An Evaluation of Graft Thickness and Vascularity. Arthrosc - J Arthrosc Relat Surg. 2019;35(12):3194–202.

    Article  Google Scholar 

  18. Snyder SJ, Arnoczky SP, Bond JL, Dopirak R. Histologic Evaluation of a Biopsy Specimen Obtained 3 Months After Rotator Cuff Augmentation With GraftJacket Matrix. Arthrosc - J Arthrosc Relat Surg. 2009;25(3):329–33.

    Article  Google Scholar 

  19. Barber FA, Herbert MA, Boothby MH. Ultimate Tensile Failure Loads of a Human Dermal Allograft Rotator Cuff Augmentation. Arthrosc - J Arthrosc Relat Surg. 2008;24(1):20–4.

    Article  Google Scholar 

  20. Cho NS, Yi JW, Rhee YG. Arthroscopic Biceps Augmentation for Avoiding Undue Tension in Repair of Massive Rotator Cuff Tears. Arthrosc - J Arthrosc Relat Surg. 2009;25(2):183–91.

    Article  Google Scholar 

  21. Mori D, Funakoshi N, Yamashita F. 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. Arthrosc - J Arthrosc Relat Surg. 2013;29(12):1911–21.

    Article  Google Scholar 

  22. Scheibel M, Brown A, Woertler K, Imhoff AB. Preliminary results after rotator cuff reconstruction augmented with an autologous periosteal flap. Knee Surg Sports Traumatol Arthrosc. 2007;15(3):305–14.

    Article  PubMed  Google Scholar 

  23. • Lederman ES, McLean JB, Bormann KT, Guttmann D, Ortega KD, Miles JW, et al. Histologic case series of human acellular dermal matrix in superior capsule reconstruction. J Shoulder Elb Surg. 2021;30(9):2146–55. Important- Illustrated healing of acellular dermal matrix (ADM) as early as 6 months after implantation and graft recellularization correlating with duration of implantation.

    Article  Google Scholar 

  24. Gupta AK, Hug K, Berkoff DJ, Boggess BR, Gavigan M, Malley PC, et al. Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Med. 2012;40(1):141–7.

    Article  PubMed  Google Scholar 

  25. Bond JL, Dopirak RM, Higgins J, Burns J, Snyder SJ. Arthroscopic Replacement of Massive, Irreparable Rotator Cuff Tears Using a GraftJacket Allograft: Technique and Preliminary Results. Arthroscopy. 2008;24(4):403-409.e1.

    Article  PubMed  Google Scholar 

  26. Giannotti S, Ghilardi M, Dell’osso G, Magistrelli L, Bugelli G, Di Rollo F, et al. Study of the porcine dermal collagen repair patch in morpho-functional recovery of the rotator cuff after minimum follow-up of 25 years. Surg Technol Int. 2014;24:348–52.

    PubMed  Google Scholar 

  27. Gupta AK, Hug K, Boggess B, Gavigan M, Toth AP. Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis: Clinical and radiographic outcomes of reconstruction using dermal tissue matrix xenograft. Am J Sports Med. 2013;41(4):872–9.

    Article  PubMed  Google Scholar 

  28. Nada AM, Debnath UK, Robinson DA, Jordan C. Treatment of massive rotator-cuff tears with a polyester ligament (Dacron) augmentation: Clinical outcome. J Bone Jt Surg - Ser B. 2010;92(10):1397–402.

    Article  CAS  Google Scholar 

  29. Audenaert E, VanNuffel J, Schepens A, Verhelst M, Verdonk R. Reconstruction of massive rotator cuff lesions with a synthetic interposition graft: A prospective study of 41 patients. Knee Surgery Sport Traumatol Arthrosc. 2006;14(4):360–4.

    Article  CAS  Google Scholar 

  30. Cvetanovich GL, Waterman BR, Verma NN, Romeo AA. Management of the Irreparable Rotator Cuff Tear. J Am Acad Orthopaedic Surgeons. 2019;27:909–17.

    Article  Google Scholar 

  31. Fan N, Yuan S, Du P, Wu Q, Li J, Kong X, et al. The effects of smoking on clinical and structural outcomes after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elb Surg. 2022;31(3):656–67.

    Article  Google Scholar 

  32. Wong I. Bridging reconstruction for massive rotator cuff tear. 2023; Available from: https://www.vumedi.com/video/bridging-reconstruction-for-massive-rotator-cuff-tear/. Accessed 12 Apr 2023.

  33. Snyder SJ, Fasulo GJ. Shoulder arthroscopy: surgical technique. Surg Technol Int. 1993;2:447–53.

    CAS  PubMed  Google Scholar 

  34. Karpyshyn J, Sparavalo S, Ma J, King JP, Wong I. Primary Rotator Cuff Bridging Reconstruction Shows Better Clinical and Radiographic Results Than Revision Bridging Reconstruction. Arthrosc Sport Med Rehabil. 2024;6(1):100869.

    Google Scholar 

  35. •• Wong I, Sparavalo S, King JP, Coady CM. Bridging Allograft Reconstruction Is Superior to Maximal Repair for the Treatment of Chronic, Massive Rotator Cuff Tears: Results of a Prospective, Randomized Controlled Trial. Am J Sports Med. 2021;49(12):3173–83. Very Important- novel RCT published in the literature comparing maximal repair to bridging reconstruction.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29(3):459–70.

    Article  PubMed  Google Scholar 

  37. Mihata T, Lee TQ, Hasegawa A, Fukunishi K, Kawakami T, Fujisawa Y, et al. Five-Year Follow-up of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears. J Bone Jt Surg - Am. 2019;101(21):1921–30.

    Article  Google Scholar 

  38. Altintas B, Scheidt M, Kremser V, Boykin R, Bhatia S, Sajadi KR, et al. Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff Tears: Does It Make Sense? A Systematic Review of Early Clinical Evidence. Am J Sports Med. 2020;48(13):3365–75.

    Article  PubMed  Google Scholar 

  39. Catapano M, de Sa D, Ekhtiari S, Lin A, Bedi A, Lesniak BP. Arthroscopic Superior Capsular Reconstruction for Massive, Irreparable Rotator Cuff Tears: A Systematic Review of Modern Literature. Arthroscopy. 2019;35(4):1243–53.

    Article  PubMed  Google Scholar 

  40. Ono Y, LeBlanc J, Bois AJ, Tsuchiya S, Thangarajah T, More KD, et al. Graft Healing Is More Important Than Graft Technique: Superior Capsular Reconstruction Versus Bridging Grafts—A Prospective Randomized Controlled Trial. Arthroscopy. 2022;38(12):3109–17.

    Article  PubMed  Google Scholar 

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Funding

None of the authors received funding sources for this review article.

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Authors and Affiliations

  1. Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

    Makena J. Mbogori & Ivan Wong

  2. Division of Orthopaedic Surgery, Nova Scotia Health, Halifax, NS, Canada

    Jie Ma & Ivan Wong

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  1. Makena J. Mbogori
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Contributions

M.M., J.M., and I.W. all contributed significantly in writing the main manuscript text, preparing figures and tables, and reviewing the manuscript.

Corresponding author

Correspondence to Ivan Wong.

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Competing Interests

Dr. Wong reports consulting fees from DePuy Mitek Inc, consulting fees from Smith and Nephew Inc, consulting fees from CONMED Corp, consulting fees from Bioventus LLC, outside the submitted work; and is an editorial board member for the American Journal of Sports Medicine (AJSM), the Orthopaedic Journal of Sports Medicine (OJSM) and Arthroscopy: The Journal of Arthroscopic and Related Surgery (ARTH); and is a board or committee member for AANA, ISAKOS, and AAC.

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Mbogori, M.J., Ma, J. & Wong, I. Surgical Management of Massive Irreparable Cuff Tears/Management of Rotator Cuff Disease: Interpositional Graft for Irreparable Posterosuperior Rotator Cuff Tears. Curr Rev Musculoskelet Med (2024). https://doi.org/10.1007/s12178-024-09903-0

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