2017 ISAKOS Biennial Congress ePoster #2254

 

Tendon-To-Bone Healing Potential Of Fascia Lata Autograft In Rotator Cuff Reconstruction

Daisuke Mori, MD, Kyoto JAPAN
Masahiko Kobayashi, MD, PhD, Kyoto JAPAN
Yoshikazu Kida, MD, PhD, Kyoto JAPAN

Kyoto Shimogamo Hospital, Kyoto, JAPAN

FDA Status Cleared

Summary

Arthroscopic second-look and histological finding in the revision cases showed good biological healing of facia lata autograft to bone of greater tuberosity

Abstract

Background

Previously, we showed high re-tear rate (89.4%) of reconstructed soft tissue after arthroscopic patch surgery in shoulders with in a group of patients with large
to massive RCTs with Goutallier stage 3 or 4 fatty degeneration of the supraspinatus and the infraspinatus. In assessing magnetic resonance imaging (MRI) findings, we found some unique cases (the fixed fascia graft remained at the anterior portion of the greater tuberosity). Moreover, we had opportunities such as arthroscopic finding and harvesting the fascia graft attached to the greater tuberosity in revision surgeries after the patch procedure. We aimed to examine the characteristic retear patterns after the patch surgery and healing potential of the graft.

Methods

A case series of 45 consecutive patients with large to massive RCTs with high-grade fatty degeneration of the supraspinatus and either low-grade or high-grade fatty degeneration of the infraspinatus treated with the fascia lata autograft patch procedure were evaluated on MRI (MRI group). According to retear patterns on MRI, cases were divided into type 1 (cuff tissue or the graft at the insertion site of rotator cuff was not observed remaining on the greater tuberosity) and type 2 (the graft and/or repaired native tendon remained at the insertion site in spite of reconstructed soft tissue retear). One case was arthroscopically evaluated at the time of Debeyer-Patte Procedure after the patch procedure (case 1). In two case at the time of reverse shoulder arthroplasty after the patch procedure, we harvested anterior portion of the greater tuberosity covered with the repaired the graft (case 2 and 3). The specimens were fixed with 10% formalin and decalcifie in an ethylenediaminetetraacetic acid solution for 4 weeks at room temperature and embedded in paraffin. Serial coronal sections were cut parallel to the long axis of the patched graft and stained with hematoxylin and eosin (HE) for light microscopic examination.

Results

In the MRI group, four cases (8.9%) had type 1 and 41 cases (89.1%) type 2 (p < 0.0001). For arthroscopic finding of case 1 with the type 2 MRI finding, the repaired graft was seen on the anterior portion of the greater tuberosity. Retear pattern of case 2 and 3 were also type 2 which were confirmed by MRI and surgical findings. Histological analysis of greater tuberosity and patched graft showed solid continuity of the graft to bone with tidemark and rich alive cells in the collagen matrix oriented parallel (case 2 and 3).

Discussion

and Conclusions: Based on MRI findings in the present study, the soft tissue conjunction between the fascia autograft and native tendons ruptured in at least 41 cases (89.1%) retear, but the graft seemed to remain at the anterior greater tuberosity. Based on arthroscopic finding in the case 1, the graft was attached to the greater tuberosity in spite of retracted native tendons. The histological analysis in two revision cases showed good biological healing of fascia autograft to bone of greater tuberosity. In both cases retear were found at the side of retracted native tendons. Fascia autograft has a good potential of tendon to bone healing.
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