2015 ISAKOS Biennial Congress ePoster #2415
Arthroscopic Rotator Cuff Repair with Graft Augmentation of Fascia Lata for Large and Massive Tears
Takeshi Kokubu, MD, PhD, Kobe JAPAN
Yutaka Mifune, MD, PhD, Kobe JAPAN
Atsuyuki Inui, MD, PhD, Kobe JAPAN
Tomoyuki Muto, MD, PhD, Kobe JAPAN
Yoshifumi Harada, MD, Kobe JAPAN
Fumiaki Takase, MD, Kobe JAPAN
Yasuhiro Ueda, MD, Kobe JAPAN
Masahiro Kurosaka, MD, Kobe, Hyogo JAPAN
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, JAPAN
FDA Status Cleared
Summary: Arthroscopic rotator cuff repair with graft augmentation of fascia lata showed good clinical outcomes with a low retear rate and improvement of abduction strength.
Excellent clinical results of arthroscopic surgical repair have been reported for rotator cuff tears, however treatment of large and massive rotator cuff tears remains challenging. Retears after surgical repair of large and massive rotator cuff tears have been reported as one of the most common complications. Single row repairs with medialization of footprint have been undergone in large and massive rotator cuff tears if the footprint fixation could not be performed. However, retear rate was high in single row repairs. We have performed single row repairs with graft augmentation of fascia lata for large and massive rotator cuff tears in order to reduce a tension at the tendon-bone repair site for prevention from retear of the repaired rotator cuff. The purpose of this study was to evaluate clinical outcomes and rotator cuff integrity after arthroscopic rotator cuff repair (ARCR) with graft augmentation of the fascia lata.
Nineteen patients who underwent ARCR but unable to perform footprint fixation were included. These patients (14 males and 5 females), with an average age of 66.2 years old (range; 52-79 year old), were diagnosed with a large and massive rotator cuff tear. Single row repairs with footprint medialization were performed in 7 cases (SR group) and graft augmentation of fascia lata in addition to single row repairs were done in 12 cases (GA group). MRI was assessed at 6 and 12 months postoperatively and a retear was defined as discontinuity of the repaired supraspinatus tendon. Japanese Orthopaedic Association (JOA) score, UCLA score, and Constant score were assessed as clinical outcomes. Abduction strength was also evaluated. Statistical comparisons of groups were performed with use of Student’s t-tests. P values =.05 were considered as statistically significant.
MRI examinations revealed 6 retears out of 7 SR cases (re-tear rate: 85%) and 2 cases out of 12 GA cases (re-tear rate: 17%) at 6 months postoperatively. There was no additional retear at 12 months. JOA score, UCLA score, and Constant score of SR groups significantly improved from 64.3 ± 8.8 to 91.0 ± 6.4, 15.6 ± 2.3 to 28.0 to 2.4, and 43.0 ± 11.2 to 72.0 ± 9.5, respectively. JOA score, UCLA score, and Constant score of GA groups also significantly improved from 75.5 ± 12.6 to 93.5 ± 8.5, 19.9 ± 3.1 to 27.8 to 3.7, and 54.3 ± 9.1 to 75.8 ± 9.7, respectively. There was no statistical difference between SR group and GA group on each score at final follow-up. The abduction strength significantly improved from 5.3 ± 2.9 to 7.6 ± 4.1 only in the GA group.
In the present study, ARCR with graft augmentation of fascia lata for large and massive rotator cuff tears showed good clinical scores with a low retear rate and improvement of abduction strength. The low retear rate might be due to reduction of tension at the cuff repair site. Therefore, graft augmentation of fascia lata would be a useful option for large and massive rotator cuff tears.