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Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. At a year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. J Bone Jt Surg Am. Histology and immunohistochemistry were performed on all samples. Significant disruption of the extracellular matrix of the repaired native supraspinatus, underlying both patches, was observed.
The patches did not generally increase cellularity, foreign body giant cell count, or vascularity compared to the control group. Interpretation - Histological and immunohistochemical analysis of native tendon tissue after patch augmentation in rotator cuff repair raises some concerns about a lack of benefit and potential for harm from these materials. Strengthening can begin once full range of motion has returned.
For symptomatic partial-thickness rotator cuff tears Table 1 , especially in a patient who is not able to comply with extended therapy, the described patch may allow for a quicker return to activity while inducing a healing response with tendon-like tissue. The deployment system for the graft, as well as the bone and tissue staples, is easy to use and provides excellent initial fixation.
As with all patches, there is a risk of inducing an inflammatory response Table 2 , but clinical data to date have not shown this complication. Meticulous surgical technique including visualization before deployment is crucial for success. Pearls and pitfalls of the surgical technique are outlined in Table 3. Surgical steps are listed in Table 4. The equipment required comprises standard arthroscopic equipment, the Bovine Bioinductive Patch System Rotation Medical , and an 8-mm cannula Arthrex.
The authors report the following potential conflicts of interest or sources of funding: J. Surgical technique using a bovine collagen bioinductive implant for arthroscopic rotator cuff augmentation. General anesthesia is administered, and the patient is placed in the lateral decubitus position.
The arm is prepared and draped in the standard fashion, and gentle inline traction is applied. A standard arthroscopic posterior viewing portal is made, and diagnostic arthroscopy is completed.
Tendon markers are placed posterior to the biceps tendon to identify the anterior edge of the supraspinatus in a percutaneous fashion. By use of a standard lateral portal, a complete bursectomy is performed to achieve optimal visualization. Subacromial bursal tissue must be removed to avoid problems with graft passage. From the lateral portal, a guidewire is placed at the lateral edge of the rotator cuff. The graft is hydrated and introduced into the lateral working portal.
The graft is then removed medially. Cannulas that are included with the patch system are placed lateral to the acromion. Five to 8 staples are used, and the tendon markers are removed. An awl is used to slightly tension the graft laterally, and then the awl is removed. Two to 3 PEEK bone staples are added to the rotator cuff footprint. Stability and placement of the graft are checked with a probe.
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Tokish, M. Received Apr 1; Accepted Oct 4. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Video 1 Surgical technique using a bovine collagen bioinductive implant for arthroscopic rotator cuff augmentation. Abstract Symptomatic partial-thickness rotator cuff tears and full-thickness tears with poor tissue quality often pose a dilemma for orthopaedic surgeons.
Surgical Technique Surgical Setup A cadaveric specimen was used in Video 1 ; however, the presented steps describe our typical approach to this clinical scenario.
Open in a separate window. Fig 1. Graft Insertion From the lateral portal, a 5-mm guidewire is placed at the lateral edge of the rotator cuff footprint Fig 2 , which will serve to guide the center line of the patch. Fig 2. Fig 3. Fig 4. Fig 5. Fixation of Graft Two additional cannulas are included in the patch system Rotation Medical. Fig 6. Fig 7. Fig 8. Discussion For symptomatic partial-thickness rotator cuff tears Table 1 , especially in a patient who is not able to comply with extended therapy, the described patch may allow for a quicker return to activity while inducing a healing response with tendon-like tissue.
Indications Symptomatic partial-thickness tears Unable to comply with protection after cuff repair Demanding lifestyle that will not allow for extended time off Contraindications May not be viable for larger rotator cuff tears involving more than one muscle Active infection Poor humeral bone quality Allergy to polylactic acid.
Risks Immune response Dislodgement of implants Structural failure Infection Limitations The technique has not been proved in a human model. Previous bovine scaffolds have had limited success. Table 3 Surgical Pearls and Pitfalls.
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