What’s the Latest?
March 2009

Soft Tissue Patching for Rotator Cuff Tears
Bernard F. Hearon, M.D.

Rotator cuff tears are extremely common shoulder problems and often require surgical repair. Small to moderate-size tears (less than 4 cm) are usually repairable by standard arthroscopic techniques (see “What’s the Latest?” September 2007). Large to massive tears (greater than 4 cm), sometimes irreparable by standard repair methods, may now be treated arthroscopically using new patch techniques.

For many years, orthopaedic surgeons have tried to patch large rotator cuff defects, particularly if the initial cuff repair attempt failed. Many different soft tissues have been used to patch the rotator cuff in the hope that the added tissue would heal and be incorporated into the patient’s own rotator cuff tendon. Most soft tissue patches or grafts taken from the patient (fascia lata autograft), from human cadavers (freeze-dried rotator cuff allograft) or from animal donors (intestinal submucosal xenograft) have not been successful (ref. 1).

Recently, however, cadaver skin allograft (acellular human dermal matrix) has been used to patch large or massive rotator cuff defects. This allograft tissue seems to act as a scaffolding into which the patient’s own rotator cuff tendon can grow and eventually replace the graft tissue. Early clinical results are encouraging. In a two-year follow-up study just published (ref. 2), 12 of 13 patients demonstrated full graft incorporation and had improvement in preoperative shoulder pain and range of motion. A multi-center study to systematically investigate the use of acellular human dermal matrix to augment rotator cuff repairs is now in progress.

We have used this new patch technique, but only in selected patients. To be a candidate for the procedure, a patient with massive rotator cuff tear must be 55 years of age or younger, have no evidence of shoulder arthritis and have sufficient rotator cuff tendon remaining to allow for patch repair. Preliminary arthroscopic evaluation of the shoulder to determine if sufficient cuff remains to accomplish the patch repair may be required.

Want more information online? Go to the Wright Medical web address www.wmt.com/softtissue/shoulder.asp to learn about GraftJacket acellular human dermal matrix to patch massive rotator cuff defects.

References

1. Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ. Porcine Small Intestine Submucosa Augmentation of Surgical Repair of Chronic Two-Tendon Rotator Cuff Tears. J Bone & Joint Surg; 88-A(6): 1238-44, June 2006.

2. Burns JP, Snyder SJ. Biologic Patches for Management of Irreparable Rotator Cuff Tears. Tech Shoulder & Elbow Surg; 10(1): 11-21, March 2009.