2023 ISAKOS Biennial Congress ePoster
Cuff Plus Procedure for the Treatment of Large to Massive Rotator Cuff Tears
Francesco De Filippo, MD, Brescia, Brescia ITALY
Marcello Motta, MD, Brescia ITALY
Marco Adriani, MD, Brescia, Brescia ITALY
Emanuele Maggini, MD, Brescia ITALY
Maristella Francesca Saccomanno, MD, PhD, Rome ITALY
Giuseppe Milano, Prof., Brescia, BS ITALY
University of Brescia, Brescia, ITALY
FDA Status Not Applicable
Summary
Tha aim of the present study was to evaluate the clinical outcome of the cuff plus procedure for the treatment of large to massive rotator cuff tears
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Abstract
Background
Biomechanical studies supported the hypothesis that anatomic reconstruction of the superior capsule and rotator cuff improves biomechanical properties in repairing delaminated rotator cuff tears. Tha aim of the present study was to evaluate the clinical outcome of the cuff plus procedure for the treatment of large to massive rotator cuff tears. The hypothesis of the study was that this new surgical technique could improve subjective and functional outcomes.
Methods
A retrospective study was conducted. Patients with large to massive rotator cuff tears of the posterosuperior rotator cuff who underwent the cuff plus procedure were included. Exclusion criteria were: shoulder stiffness, cuff-tear arthropathy, glenohumeral osteoarthritis, symptomatic acromioclavicular joint osteoarthritis, previous fractures and/or previous surgery to the same shoulder. Indication to the cuff plus was always confirmed arthroscopically after assessing the long head of the biceps tendon status and cuff tear morphology and delamination. All patients underwent the same surgical technique and rehabilitation protocol. The long head of the biceps tendon was freed from its groove using an electrocautery device and then mobilized posteriorly. Two #2 high-strength non-absorbable braided sutures were passed about 5 mm apart through the distal aspect of the intraarticular part of the tendon. The tendon was then released one centimeter distal to the most lateral suture and re-routed over the footprint of the posterior aspect of the supraspinatus tendon. A standard single row cuff repair, based on tear shape, was then performed by using two double or triple loaded anchors. Sutures were passed through the rotator cuff and through the most lateral part of the biceps stump to obtain a robust and solid construct. Primary outcome was the ASES score. Secondary outcomes were: QuickDASH and WORC score. Moreover, a postoperative magnetic resonance imaging was performed six months postoperatively to evaluate tendon integrity. A paired t-test was used to compare pre and postoperative outcomes. Significance was set at p < 0.05.
Results
The study included 11 males and 4 females. Mean age (+ SD) of patients was 63.3 ± 7.83 years. Mean follow-up was 28.40 ± 5.74. Comparison between pre- and postoperative functional scores showed significant clinical improvement (p < 0.001). Postoperative imaging showed higher rate of tendon integrity compared to the current literature results.
Conclusion
Arthroscopic cuff plus technique for the treatment of large to massive rotator cuff tears provides satisfactory functional and structural outcomes.