2015 ISAKOS Biennial Congress ePoster #2430

Early Clinical Outcomes of Arthroscopic Rotator Cuff Repair with Synthetic PTFE Patches for Patients with Massive to Irreparable Tears

Tom Morrison
Patrick H. Lam, PhD, Sydney, NSW AUSTRALIA
George A. Murrell, MD, PhD, Sydney, NSW AUSTRALIA
Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, New South Wales, AUSTRALIA

FDA Status Cleared

Summary: Patients receiving synthetic patches for massive and irreparable rotator cuff tears had significantly lower retear rates than those repaired using traditional suture-anchor techniques.

Abstract:

Background

Massive tears of the rotator cuff tendons are a common cause of shoulder morbidity. The current approach of arthroscopic suture-anchor repair has met limited success and cannot be used for so called irreparable tears. The use of synthetic polyterafluoroethylene patches has shown potential in small studies. No short term outcome studies of synthetic patches have taken place for large groups of patients. No comparison of short term patient outcomes has taken place between alternatives of synthetic patches. The aim of this study was to evaluate short term outcomes of patients receiving patches for massive to irreparable rotator cuff tears.

Methods

This was a retrospective case control study with prospective collected data. Patients underwent an arthroscopic rotator cuff repair using either suture-anchor repair (control group, n=100), Bard-Felt synthetic patch (Bard Group, n=28, Bard Expanded PTFE Felt: C.R Bard, Warwick, RI, USA), or Gore-Tex synthetic patch (Gore Group, n=39, Gore-Tex Expanded PTFE Patch: W.L. Gore & Associated, Flagstaff, AZ, USA). The mean tear size for patient who had rotator repair with the Bard PTFE felt (n=28) was 12cm2 ± 1 cm2 (mean ± SEM). Mean tear size for patients who had RCR with Gore Tex patch (n=39) was 14cm2 ± 1cm2. Mean tear size for the control cohort who underwent suture-anchor repair (n=100) was 13cm2 ± 1cm2. Patients ranked pain and functional scores were recorded pre and post-operatively at one, six, 12 and six months with a modified L’Instalata Questionnaire. Shoulder strength and range of motion were also recorded at each visit. Ultrasound was used to evaluate the repair integrity at six months post-surgery.

Results

At six months there was a significant difference in retear rates between the patch (Bard 4%, Gore 3%) and suture-anchor repair groups (25%) (p<0.01). Supraspinatus strength in the Bard group was significantly stronger than Gore at 6 weeks (22N vs 12N, p=0.04) and 12 weeks (29N vs 17N, p=0.02), and suture-anchor repair at 6 weeks (22N vs 10N, p=0.01). Patients who had the repair with the Gore patch had significantly more extreme pain than Bard patients (p=0.04) and suture anchor repair patients (p<0.01). Patients who had the repair with the Bard patch had significantly greater range of motion on internal rotation at 6 months than both Gore (+ 3 vertebra levels, p<0.01) and suture-anchor repairs (+2 vertebra levels, p<0.01), and Gore had significantly lower strength than Bard (63N vs 87N, p=0.01).

Conclusions

Patients receiving synthetic patches for massive and irreparable rotator cuff tears had significantly lower retear rates than those repaired using traditional suture-anchor techniques. Patients receiving Bard patches experienced faster improvements of supraspinatus strength than those with a tear repaired by use of a Gore patch or no patch. Patients receiving Gore patches have a higher frequency of extreme pain than patients with Bard patches or no patch.