Results of Arthroscopic Repair of Massive “Irreparable” Tears with Synthetic Patch and PRP

Introduction:
Treatment of massive “irreparable” rotator cuff tears (MIRCT) is challenging. Possible treatments include – arthroscopic repair, partial repair/marginal convergence, superior capsule reconstruction, balloon implantation, arthroplasty and more. Often complete repair cannot be achieved due to severe tendon retraction and poor tendon tissue quality.

We assessed the results of arthroscopic rotator cuff repair (aRCR) using a synthetic patch for bridging and augmenting MIRCT.

Materials and Methods:
A retrospective analysis of prospectively collected data. All patients had MIRCT with tear retraction beyond the glenoid margin. Patient demographics, diagnosis and comorbidities were recorded. The intra-operative findings and treatment were recorded. Constant Score, Range of motion (ROM), Shoulder Subjective Value (SSV), patient satisfaction, Video recording of ROM and Ultrasound or MRI scan at final follow-up (FU) were recorded.

Results:
Between 2009 to 2017, 30 patients (mean age 60 y) underwent arthroscopic MIRCT repair with a synthetic patch and PRP. Mean preoperative CS was 36.0 and SSV was 1.14/10. Mean FU of 51 months (24 to 89). Last FU mean CS was 74.5, SSV was 7.6/10.

One patient developed an acute infection which resolved with arthroscopic washout, patch removal and antibiotic treatment. One patient needed removal of a loose anchor but made a full recovery. 3 patients were converted to a Reverse Total Shoulder Arthroplasty (rTSA). The histopathologic examination of the retrieved patches showed good fibroconnective tissue growth within and around the patch. There were no signs of inflammation, foreign body reaction or infection.

Ultrasound or MRI scan in all remaining cases showed good integrity of the repair with the patch.

Conclusions:
aRCR with synthetic patch and PRP, shows good long term clinical and imaging outcomes. Histopathologic analysis of patches retrieved prove it to be an excellent scaffold for incorporation of fibroconnective tissue growth.