Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder

Table 1 Results of allograft interposition

Study and graft	Number	Ave age (yr)	F/U(mo)	Outcome scorePre/post/P value	ROMPre/post/P value	Conclusion
Neviaser et al[40] Freeze dried rotator cuff	16	58	20	13/16 excellent results Criteria used: Nocturnal pain Degree of abduction	> 160:6 120-160:3 90-120:5 < 90:2 Average: 122.5	In our patients there has been no sign that the grafts were rejected and the goals of the procedure to improve motion and to relieve pain usually were attained
Nasca et al[41] Freeze dried rotator cuff	7	62	42	Good 2, fair 2, poor 3	FF: 78/90 Abd: 69.2/84	Freeze dried rotator cuff allografts do not appear to be of significant value in the surgical management of chronic massive rotator cuff tears
Venouziou et al[43] HDA	14	54.6	30.2	ASES: 23.8/72.3/P = 0.001	FF: 73.6/129.3/P = 0.002 ABD: 67.5/117.9/P = 0.002 ER: 7.9/ 43.2/P = 0.001	The ROM and the functional outcome were all improved in the patients with less than 2 cm tendon gap. In the case of larger tendon defects the outcome is unpredictable
Moore et al[12] 26 Patellar 5 Achilles 1 Quadriceps	32	59.1	31.3	UCLA: 12.1/26.1/P < 0.001 Excellent 3, good 12, fair 8, poor 5	Active FF UCLA: 3/3.8/P < 0.17 Resisted FF UCLA: 2.9/3.7/P < 0.002	15/15 showed failure on MRI. Allograft reconstruction for massive, irreparable rotator cuff tears is not recommended
Bond et al[42] HDA	16	54.4	28.8	UCLA: 18.4/30.4/P = 0.0001 Excellent 4, good 9, Fair 3, Poor 0 53.8/84/P = 0.0001	FF: 106/142/P = 0.0001 ER: 43/47.2/NR	Our study supports the hypothesis that GJA is a viable treatment option for surgical salvage in select cases of symptomatic massive, irreparable rotator cuff pathology
Gupta et al[44] HDA	24	63	36	ASES: 66.6/88.7/P = 0.003 SF-12: 48.8/56.8/P = 0.03	FF: 111.7/157.3/P = 0.0002 ABD: 105/151.7/P = 0.0001 ER: 46.2/65.1/P = 0.001	Human dermal interposition repair of massive rotator cuff tears through a mini-open approach is a reproducible technique that leads to significant improvement in pain, ROM, strength and subjective scores
Wong et al[45] HDA (Extreme)	45	53.6	24 min	UCLA: 18.4/27.5/P < 0.001 ASES: 84.1 (post)		Arthroscopic rotator cuff reconstruction with GraftJacket (Human dermal allograft) is safe and is associated with high patient satisfaction, without the morbidity of tendon transfer or arthroplasty
Ito et al[47] Allograft fascia lata	9	62.8	35	JOA: 47.9/91.7/P = 0.0059	FF: 84.4/159.6/P < 0.005 ADB: 62.2/163.3/P < 0.005 ER: 43.9/41.7/NR	Patch Grafts are considered to have the advantages of achieving anatomical repair with minimal restriction of range of motion and minimal occurrence of re-tearing
Modi el al[46] HDA	61	62.6	42	OSS: 26/42/P = 0.001	FF: 97/160/P = 0.001 ABD: 90/155/P = 0.001 ER: 42/60/0.04	GraftJacket allograft regenerative tissue matrix provides a very good option for bridging irreparable rotator cuff tears in the short to medium term

HDA: Human Dermal allograft; FF: Forward flexion; Abd: Abduction; ER: External rotation; UCLA: University of California-Los Angeles; ASES: American Shoulder and Elbow Surgeon evaluation form; JOA: Japanese Orthopaedic Association; OSS: Oxford shoulder score.

Table 2 Results of autograft interposition

Study and graft	Number	Ave age (yr)	F/U(mo)	Outcome ScorePre/post/P value	ROMPre/post/P value	Conclusion
Mori et al[50] Tensor fascia	24	65.9	35.5	ASES: 40.8/94.1/P < 0.001 Constant: 37.4/81.1/P < 0.001	FF: 114/160.8 ER: 27.9/46	The patch graft procedure showed an 8.3% retear rate for the repaired ISP with improved clinical scores and recovery of muscle strength
Sano et al[48] Biceps	14	64	28	JOA: 13.1/22.9/P = 0.0019	Active elevation 69/149/P = 0.0010	LHB tendon patch grafting provided significant improvement in both the active elevation angle and for the JOA score. The LHB tendon patch grafting seems to be one of the useful options for surgical treatment of irreparable massive rotator cuff tears
Rhee et al[49] Biceps	31 15 open 16 arthro	61	32	Constant 48.4/81.8/P < 0.001 UCLA 12.5/31.1/P < 0.001	FF: 124/162/P < 0.001 ABD: 134/168/P < 0.001 ER: 38/47/P = 0.46	An augmentation technique using the tenotomised biceps as a potential graft for rotator cuff tears is particularly useful in bridging the gap in immobile massive rotator cuff tears with posterior defects and retraction. Differences in postoperative clinical results between the open and arthroscopic groups were not statistically significant

FF: Forward flexion; Abd: Abduction; ER: External rotation; UCLA: UCLA: University of California-Los Angeles; ASES: American shoulder and elbow surgeon evaluation form; JOA: Japanese orthopaedic association.

Table 3 Results of Xenograft interposition

Study	Number	Ave age (yr)	F/U(mo)	Outcome scorePre/post/P value	ROMPre/post/P value	Conclusion
Badhe et al[51] PDC (Permacol)	10	65.7	54	Constant: 42/62/P = 0.0004	Post-operative: Active abd: 89 Passive abd: 98	Porcine dermal collagen is effective as an augmentation graft in the treatment of chronic extensive rotator cuff tears, providing excellent pain relief with a moderate improvement in active ranges of motion and strength
Soler et al[52] PDC (Permacol)	4	76		Reduced range and strength, increased pain	Mean active ER: 50 Not recorded	While the use of porcine dermal collagen (Permacol) has many obvious advantages, we do not advocate using it to bridge irreparable defects

PDC: Porcine dermal collagen; FF: Forward flexion; Abd: Abduction; ER: External rotation.

Table 4 Results of Synthetic interposition

Study	Number	Ave age (yr)	Follow-up(mo)	Outcome ScorePre/post/P value	ROMPre/post/P value	Conclusion
Nada el al[54] Polyester ligament (Dacron)	21	66.5	36	Constant: 46.6/84.5/P < 0.001 Excellent 17, good 2, fair 1, poor 1	FF: 65/120/P < 0.001 Abd: 60/120/P < 0.001 ER: 39/57/P = 0.01	Polyester (Dacron) ligament augmentation can result in a pain free successful return of function in active symptomatic patients with massive chronic tears of the rotator cuff
Hirooka et al[13] Gore-Tex soft tissue patch	26	62	44	JOA: 57.8/86/NR		Good clinical results, especially pain relief, could be achieved with this procedure in both the small- and the large-patch groups, but good abduction strength was obtained only in the small-patch group
Audenaert et al[55] Mersilene mesh	41	67	43	Constant: 25.7/72.1/P < 0.001	FF: 69.2/136/P < 0.001 Abd: 68.4:133.7/P < 0.001	A polyester patch for the closure of massive rotator cuff tears is a satisfying procedure in this complex and technically challenging group of patients
Ozaki et al[14] Teflon felt	25	67.3	42	23: No pain, 2: Some pain	ER: 32.4/38.2/P < 0.05 16: Normal, 7: > 120 2: < 30	Of 25 patients with massive rotator cuff tears, 23 had satisfactory functional results
Visuri et al[56] Carbon fibre patch	10	53.9	50.4	Excellent 7, good 2, poor 1	Abd: 73/166/NR	A carbon fiber tow application combined with Neer's anterior acromioplasty seems useful in the reconstruction of large tears of the rotator cuff

FF: Forward flexion; Abd: Abduction; ER: External rotation; JOA: Japanese Orthopaedic Association.