Outcomes After Open Revision Repair of Massive Rotator Cuff Tears With Biologic Patch Augmentation

Authors:

Maximilian Petri, Ryan J Warth, Marilee P Horan, Joshua A Greenspoon, Peter J Millett

Abstract:

The surgical management of rotator cuff tears has been successful in reducing symptoms and improving shoulder function in the most affected patients. However, there are several surgical factors that have been found to negatively affect patient outcomes. These include large tear size, poor tendon quality, increased degree of tendon retraction, and the presence of fatty degeneration, among many other factors. Therefore, patients with massive, retracted rotator cuff tears are less likely to achieve an optimal outcome using standard rotator cuff repair constructs, particularly in a revision situation. As a result, new methods of tendon repair have been developed to improve outcomes in this subgroup of patients. Specifically, rotator cuff augmentation using biological patches has been proposed as a method to improve repair integrity, particularly when tendon quality is less than optimal.

Patch augmentation can be performed using open, mini-open, or arthroscopic techniques. A variety of biological patch materials have been used with favorable results, including autologous fascia lata, human acellular dermis, and porcine dermal collagen in addition to various synthetic grafts composed of poly-L-lactic acid, polyester, polypropylene, polytetra-fluoroethylene, or polyurethane. Some studies, however, have not reported good results with biological patches.

Although the most appropriate materials for the augmentation of rotator cuff repairs has not yet been defined, preliminary biomechanical and clinical evidence suggest that rotator cuff augmentation may be a safe and effective method for the treatment of massive, retracted rotator cuff tears. However, limited data exist regarding minimum 2-year clinical outcomes after rotator cuff augmentation using acellular dermal matrix allografts in this group of patients. In addition, the treatment of rota- tor cuff tendon deficiency in the setting of otherwise healthy rotator cuff muscles has not been well studied. Finally, data regarding the use of biological patch augmentation in revision rotator cuff repair are currently lacking. The purpose of this study was to assess minimum 2-year clinical outcomes after open revision biologic patch augmentation in patients with massive rotator cuff retears who had deficient rotator cuff tendons with healthy rotator cuff muscles. We hypothesized that revision rotator cuff repair with biologic patch augmentation using human acellular dermal allograft would be safe, effective, and would result in significant improvement in clinical outcomes scores when compared with preoperative baselines in patients with massive rotator cuff tears.

For the complete study: Outcomes After Open Revision Repair of Massive Rotator Cuff Tears With Biologic Patch Augmentation

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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