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Mid-term results of arthroscopic porcine dermal xenograft augmentation for irreparable massive rotator cuff tears: a 3-year follow-up study
Arthrosc Orthop Sports Med 2017;4:66-73
Published online July 1, 2017;  https://doi.org/10.14517/aosm16015
© 2017 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Sang Jin Cheon, Ji Min Lee, Sung Jin An, Hyo Yeol Lee

Department of Orthopedic Surgery, School of Medicine, Pusan National University, Busan, Korea
Correspondence to: Sang Jin Cheon,
Department of Orthopedic Surgery, Pusan National University Hospital, School of Medicine, Pusan National University, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea.
Tel: +82-51-240-7248, Fax: +82-51-247-8395, E-mail: scheon@pusan.ac.kr
Received November 8, 2016; Revised April 24, 2017; Accepted April 25, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: In this study we assessed the mid-term results of arthroscopic augmentation with porcine dermal xenografts for irreparable rotator cuff tears.
Methods: Between February 2010 and February 2012, ten patients with irreparable rotator cuff tears were treated with arthroscopic augmentation with porcine dermal xenografts. All patients were followed up for at least three years. Clinical scores the University of California, Los Angeles (UCLA) scoring system, the Constant score, and the American Shoulder and Elbow Surgeons (ASES) shoulder score were evaluated both preoperatively and postoperatively in all patients. We evaluated repair status in terms of radiological outcome through magnetic resonance imaging after a mean 10.3 months of operation.
Results: The study population consisted of seven men and three women with a mean age of 64.9 years (range, 53–72 years) and a mean follow-up of 42.5 months (range, 36.2–47.1 months). The clinical outcome significantly improved for all patients. The mean UCLA score increased from 15.50 preoperatively to 30.10 postoperatively (P < 0.001). The mean Constant score improved from 59.80 to 83.90 (P = 0.001), and the mean ASES score, from 58.60 to 85.30 (P = 0.001). However, there were no significant differences between the intact group and the retear group in terms of clinical results. Magnetic resonance imaging at the follow-up examinations demonstrated patch continuity between the native cuff and the greater tubercle in five patients (50%). We did not observe any significant difference between the intact group and retear group in terms of, preoperatively, the size of the tear, degree of muscle atrophy, smoking status, use of steroids, and, postoperatively, the rehabilitation protocol.
Conclusion: We found that arthroscopic repairs using porcine dermal xenografts for irreparable massive rotator cuff tears is associated with improved clinical outcome in most patients, despite a retear rate of 50%. Thus, we conclude that porcine dermal patch augmentation can be one of the treatment options for patients with either reparable subscapularis or infraspinatus.
Keywords : Arthroscopic repair; Irreparable massive rotator cuff tear; Porcine dermal xenograft
References
  1. Boes MT, McCann PD, Dines DM. Diagnosis and management of massive rotator cuff tears: the surgeon’s dilemma. Instr Course Lect 2006;55:45-57.
    Pubmed
  2. Duralde XA, Bair B. Massive rotator cuff tears: the result of partial rotator cuff repair. J Shoulder Elbow Surg 2005;14:121-7.
    Pubmed CrossRef
  3. Gartsman GM. Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression. J Bone Joint Surg Am 1997;79:715-21.
    CrossRef
  4. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 2000;82:505-15.
    Pubmed CrossRef
  5. Klinger HM, Steckel H, Ernstberger T, Baums MH. Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors. Arch Orthop Trauma Surg 2005;125:261-6.
    Pubmed CrossRef
  6. Liem D, Lengers N, Dedy N, Poetzl W, Steinbeck J, Marquardt B. Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy 2008;24:743-8.
    Pubmed CrossRef
  7. Elhassan B, Endres NK, Higgins LD, Warner JJ. Massive irreparable tendon tears of the rotator cuff: salvage options. Instr Course Lect 2008;57:153-66.
    Pubmed
  8. Gerber C, Maquieira G, Espinosa N. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am 2006;88:113-20.
    Pubmed
  9. Pearsall AW 4th, Madanagopal SG, Karas SG. Transfer of the latissimus dorsi as a salvage procedure for failed debridement and attempted repair of massive rotator cuff tears. Orthopedics 2007;30:943-9.
    Pubmed
  10. Glanzmann MC, Flury M, Simmen BR. Reverse shoulder arthroplasty as salvage procedure after deltoid muscle flap transfer for irreparable rotator cuff tear: a case report. J Shoulder Elbow Surg 2009;18:e1-2.
    Pubmed CrossRef
  11. John M, Pap G, Angst F, et al. Short-term results after reversed shoulder arthroplasty (Delta III) in patients with rheumatoid arthritis and irreparable rotator cuff tear. Int Orthop 2010;34:71-7.
    Pubmed KoreaMed CrossRef
  12. 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. A randomized, controlled trial. J Bone Joint Surg Am 2006;88:1238-44.
    CrossRef
  13. Sano H, Mineta M, Kita A, Itoi E. Tendon patch grafting using the long head of the biceps for irreparable massive rotator cuff tears. J Orthop Sci 2010;15:310-6.
    Pubmed CrossRef
  14. Badhe SP, Lawrence TM, Smith FD, Lunn PG. An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elbow Surg 2008;17(1 Suppl):35S-9S.
    Pubmed CrossRef
  15. Neviaser JS, Neviaser RJ, Neviaser TJ. The repair of chronic massive ruptures of the rotator cuff of the shoulder by use of a freeze-dried rotator cuff. J Bone Joint Surg Am 1978;60:681-4.
    Pubmed CrossRef
  16. Audenaert E, Van Nuffel 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 Surg Sports Traumatol Arthrosc 2006;14:360-4.
    Pubmed CrossRef
  17. Hirooka A, Yoneda M, Wakaitani S, et al. Augmentation with a Gore-Tex patch for repair of large rotator cuff tears that cannot be sutured. J Orthop Sci 2002;7:451-6.
    Pubmed CrossRef
  18. Lenart BA, Martens KA, Kearns KA, Gillespie RJ, Zoga AC, Williams GR. Treatment of massive and recurrent rotator cuff tears augmented with a poly-l-lactide graft, a preliminary study. J Shoulder Elbow Surg 2015;24:915-21.
    Pubmed CrossRef
  19. Moore DR, Cain EL, Schwartz ML, Clancy WG Jr. Allograft reconstruction for massive, irreparable rotator cuff tears. Am J Sports Med 2006;34:392-6.
    Pubmed CrossRef
  20. Ito J, Morioka T. Surgical treatment for large and massive tears of the rotator cuff. Int Orthop 2003;27:228-31.
    Pubmed KoreaMed CrossRef
  21. Aurora A, McCarron J, Iannotti JP, Derwin K. Commercially available extracellular matrix materials for rotator cuff repairs: state of the art and future trends. J Shoulder Elbow Surg 2007;16(5 Suppl):S171-8.
    Pubmed CrossRef
  22. 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.
    Pubmed
  23. Mellado JM, Calmet J, Olona M, et al. Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings. AJR Am J Roentgenol 2005;184:1456-63.
    Pubmed CrossRef
  24. Saupe N, Pfirrmann CW, Schmid MR, Jost B, Werner CM, Zanetti M. Association between rotator cuff abnormalities and reduced acromiohumeral distance. AJR Am J Roentgenol 2006;187:37682.
    Pubmed CrossRef
  25. Dejardin LM, Arnoczky SP, Ewers BJ, Haut RC, Clarke RB. Tissueengineered rotator cuff tendon using porcine small intestine submucosa. Histologic and mechanical evaluation in dogs. Am J Sports Med 2001;29:175-84.
    Pubmed CrossRef
  26. Derwin KA, Baker AR, Spragg RK, Leigh DR, Iannotti JP. Commercial extracellular matrix scaffolds for rotator cuff tendon repair. Biomechanical, biochemical, and cellular properties. J Bone Joint Surg Am 2006;88:2665-72.
    Pubmed
  27. Harper C. Permacol: clinical experience with a new biomaterial. Hosp Med 2001;62:90-5.
    Pubmed CrossRef
  28. Jarman-Smith ML, Bodamyali T, Stevens C, Howell JA, Horrocks M, Chaudhuri JB. Porcine collagen crosslinking, degradation and its capability for fibroblast adhesion and proliferation. J Mater Sci Mater Med 2004;15:925-32.
    Pubmed CrossRef
  29. Soler JA, Gidwani S, Curtis MJ. Early complications from the use of porcine dermal collagen implants (Permacol) as bridging constructs in the repair of massive rotator cuff tears. A report of 4 cases. Acta Orthop Belg 2007;73:432-6.
    Pubmed
  30. Barber FA, Herbert MA, Coons DA. Tendon augmentation grafts:biomechanical failure loads and failure patterns. Arthroscopy 2006;22:534-8.
    Pubmed CrossRef