Clinical Outcomes Following Biologically Enhanced Patch Augmentation Repair as a Salvage Procedure for Revision Massive Rotator Cuff Tears

Lukas N. Muench, Cameron Kia, Aulon Jerliu, Ariel A. Williams, Daniel P. Berthold, Mark P. Cote, Mary Beth McCarthy, Robert A. Arciero, Augustus D. Mazzocca

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Abstract

Purpose: To evaluate the clinical outcomes of patients who underwent biologically enhanced patch augmentation repair for the treatment of revision massive rotator cuff tears. Methods: Twenty-two patients who underwent arthroscopic and mini-open rotator cuff repair using a patch augmented with platelet-rich plasma and concentrated bone marrow aspirate (cBMA) for revision massive (≥2 tendons) rotator cuff tears from 2009 to 2014, with a minimum 1-year follow-up, were included in the study. In this procedure the medial side of the graft is secured to the rotator cuff tendon remaining medially. American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test, and postoperative Single Assessment Numerical Evaluation scores were evaluated. To determine the clinical relevance of ASES scores, the minimal clinically important difference, substantial clinical benefit (SCB), and the patient-acceptable symptomatic state (PASS) thresholds were used. Clinical success or failure was defined based on whether the patient reached the SCB threshold. In the laboratory, cellular counting along with the concentration of connective tissue progenitor cells were performed on patch samples from the day of surgery. Scaffolds were processed histologically at days 0, 7,14, and 21 of culture. Results: Patients had significant improvement in the Simple Shoulder Test (2.6 ± 3.0pre vs 5.2 ± 4.2post, P = .01), whereas improvement in pain scores was found to be nonsignificant (5.6 ± 2.5pre vs 4.2 ± 3.4post, P = .11) at final follow-up. Mean ASES improved by Δ14.6 ± 33.4 points; however, this did not reach statistical significance (40.2 ± 21.6pre vs 53.9 ± 31.4post, P = .10). With regards to ASES score, 45% of patients achieved the minimal clinically important difference, 41% the SCB, and 32% reached or exceeded the PASS criteria. At 21 days, there was a significantly greater cell count in scaffolds from patients who had clinical success than those who were failures (P = .02). Conclusions: Only 41% of patients undergoing biologically enhanced patch augmentation repair reached substantial clinical benefit, whereas 32% reached or exceeded the PASS criteria. Level of Evidence: Case Series: Level IV.

Original languageEnglish (US)
Pages (from-to)1542-1551
Number of pages10
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume36
Issue number6
DOIs
StatePublished - Jun 2020

Bibliographical note

Funding Information:
The authors report the following potential conflict of interest or source of funding: A.D.M. receives consulting fees as well as research support from Arthrex. The company had no involvement in the study design, data collection, or final manuscript. R.A.A. receives research support from Arthrex. In addition, R.A.A. is a consultant for Biorez. M.P.C. receives personal fees from the Arthroscopy Association of North America (AANA) for the Arthroscopy Journal. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

Publisher Copyright:
© 2020 Arthroscopy Association of North America

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  • Journal Article

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