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Synthetic patch augmentation of irreparable tears of the rotator cuff
ESSKA Academy. Hackney R. Nov 8, 2019; 284404; epESA-07 Topic: Open Surgery
Mr. Roger Hackney
Mr. Roger Hackney
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Synthetic patch augmentation of irreparable tears of the rotator cuff

ePoster - epESA-07

Topic: Other Surgical Options

Hackney R.
Spire Hospital, Leeds, United Kingdom

There has been a surge of interest in management of massive tears of the rotator cuff. Options include rehabilitation, partial repair and debridement all of which have reasonable short to medium term outcomes published. Recent innovations include balloon arthroplasty and superior capsular reconstruction. Where repair is achievable there is a high recurrence rate of tear with well-identified risk factors such as high fatty degeneration index, size of tear, quality of tendon and tension on the repair. Very tight repairs which leave defects in the cuff are doomed to failure of repair and poorer outcomes beyond 2 years compared with intact tendons.
This is a single surgeon series using a synthetic patch to bridge defects and augment repair of rotator cuff tendons which are not fully repairable, even using an open approach. 20 consecutive patients were followed up with scores taken pre-op and 6 months post-operatively at routine review.
Every patient with a large to massive tear who had failed conservative treatment underwent an arthroscopy with mobilisation of the tendons and if achievable, an open repair augmented with a patch. It should be emphasised that these tendons were not full repairable and fall into a poor prognosis category. In some cases very large defects were bridged.
Average OSS preoperatively was 19, with a range of 4 - 33.
At 6-12 months the OSS was 47, a mean improvement of 27 with a range of 13 -41.
It is the author's experience that improvement continues beyond 6 months and the risk of recurrence of tear is very low. Only patients who are slow to improve undergo diagnostic ultrasound scan. There were no recurrences of tear in this series. Two required capsular release for stiffness. At arthroscopy the patch material is completely enclosed in native tissue.
A synthetic patch can be used to bridge irreparable defects in the rotator cuff with outstanding results at 6 months
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