Clinical and radiological outcomes of large and massive rotator cuff tears treated with arthroscopic augmented rotator cuff repairs using extracellular matrix patch
ESSKA Academy. Narvani A. 11/08/19; 286377
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Clinical and radiological outcomes of large and massive rotator cuff tears treated with arthroscopic augmented rotator cuff repairs using extracellular matrix patch

ESA Free Oral Presentations

Topic: Biological Augmentation

Consigliere P.1, Bernasconi A.2, Dimock R.1, Narvani A.1
1Ashford and St Peter's Hospitals NHS FT, Trauma and Orthopaedics, Chertsey, United Kingdom, 2Royal National Orthopaedic Hospital NHS FT, Trauma and Orthopaedics, London, United Kingdom

Background: Healing of rotator cuff tendons is still a challenge especially in the elderly population. Rotator cuff repairs (RCR) failure rate is still high(25-70%).
Objective: Our hypothesis is that augmentation patches can offer both a biomechanical and a biological support to RCR for large-massive tears; they can help to obtain a more stable construct and support the healing process reducing the failure rate.
Purpose: To assess the structural integrity of a series of augmented RCR utilising magnetic resonance imaging(MRI) and to report the functional outcomes at a minimum follow-up of 1-year.
Methods: Between 2014 and 2016, fifty-one consecutive patients underwent arthroscopic double-row RCR of large-massive tears with extracellular porcine dermal matrix augmentation. At 1-year follow-up, MRI scan was performed in 38 patients assessing the integrity of the repair. Oxford Shoulder Score (OSS), Constant Score (CS) and Visual Analogue Scale (VAS) pain score, together with shoulder range of motion (ROM) were used preoperatively and at 3, 6, 12 months and final follow-up.
Results: Patient mean age was 70(range, 53-81). Mean follow-up was 17.2 months(range, 12-24). MRI scans showed 7 RC full tears(18.4%). Both OSS and CS improved progressively until 12 months, with statistically significant improvement already at 3 months(p< 0.001). Mean CS improved from 40.8 ±10.1 pre-operatively to 75.8±9.81 at 1-year follow-up(p< 0.05). Mean OSS increased from 29 ±7.6 pre-operatively to 45.7 ±4.3 at 1-year follow-up(p< 0.05). ROM significantly improved at the last follow-up: mean abduction improved from 93.8degrees ±30degrees to 159.1degrees ±22degrees(p< 0.05); mean forward flexion from 105.1degrees ±33degrees to 167.2degrees ±23degrees(p< 0.05); mean external rotation from 60.7degrees ±8.2degrees to 68.3degrees ±3.7degrees(p< 0.001). The pain also decreased significantly postoperatively(p< 0.001). No complications or adverse reactions occurred.
Conclusion: This study showed a healing failure rate of 18.4%, lower than what is reported in literature for standard RCR of large-massive tears in similar cohort to ours. Augmented patches were shown to be a safe and reliable support to the repairs. Patients recovered good shoulder function and returned to their activities of daily living with good control of pain. This study highlights the need for randomised controlled trials comparing outcome of augmented RCR to that of standard repairs.
Clinical and radiological outcomes of large and massive rotator cuff tears treated with arthroscopic augmented rotator cuff repairs using extracellular matrix patch

ESA Free Oral Presentations

Topic: Biological Augmentation

Consigliere P.1, Bernasconi A.2, Dimock R.1, Narvani A.1
1Ashford and St Peter's Hospitals NHS FT, Trauma and Orthopaedics, Chertsey, United Kingdom, 2Royal National Orthopaedic Hospital NHS FT, Trauma and Orthopaedics, London, United Kingdom

Background: Healing of rotator cuff tendons is still a challenge especially in the elderly population. Rotator cuff repairs (RCR) failure rate is still high(25-70%).
Objective: Our hypothesis is that augmentation patches can offer both a biomechanical and a biological support to RCR for large-massive tears; they can help to obtain a more stable construct and support the healing process reducing the failure rate.
Purpose: To assess the structural integrity of a series of augmented RCR utilising magnetic resonance imaging(MRI) and to report the functional outcomes at a minimum follow-up of 1-year.
Methods: Between 2014 and 2016, fifty-one consecutive patients underwent arthroscopic double-row RCR of large-massive tears with extracellular porcine dermal matrix augmentation. At 1-year follow-up, MRI scan was performed in 38 patients assessing the integrity of the repair. Oxford Shoulder Score (OSS), Constant Score (CS) and Visual Analogue Scale (VAS) pain score, together with shoulder range of motion (ROM) were used preoperatively and at 3, 6, 12 months and final follow-up.
Results: Patient mean age was 70(range, 53-81). Mean follow-up was 17.2 months(range, 12-24). MRI scans showed 7 RC full tears(18.4%). Both OSS and CS improved progressively until 12 months, with statistically significant improvement already at 3 months(p< 0.001). Mean CS improved from 40.8 ±10.1 pre-operatively to 75.8±9.81 at 1-year follow-up(p< 0.05). Mean OSS increased from 29 ±7.6 pre-operatively to 45.7 ±4.3 at 1-year follow-up(p< 0.05). ROM significantly improved at the last follow-up: mean abduction improved from 93.8degrees ±30degrees to 159.1degrees ±22degrees(p< 0.05); mean forward flexion from 105.1degrees ±33degrees to 167.2degrees ±23degrees(p< 0.05); mean external rotation from 60.7degrees ±8.2degrees to 68.3degrees ±3.7degrees(p< 0.001). The pain also decreased significantly postoperatively(p< 0.001). No complications or adverse reactions occurred.
Conclusion: This study showed a healing failure rate of 18.4%, lower than what is reported in literature for standard RCR of large-massive tears in similar cohort to ours. Augmented patches were shown to be a safe and reliable support to the repairs. Patients recovered good shoulder function and returned to their activities of daily living with good control of pain. This study highlights the need for randomised controlled trials comparing outcome of augmented RCR to that of standard repairs.
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