Our Summary

This research paper discusses the challenge of treating large, unrepairable tears in the rotator cuff, which is a group of muscles and tendons in the shoulder. One possible solution is using a graft repair, where a piece of tissue is inserted to help bridge the gap left by the tear. The tissue can come from several sources: from the patient themselves (autograft), from a donor (allograft), from a special kind of cell matrix, or from synthetic materials.

The researchers are trying to figure out which of these materials works best, both in terms of physical properties and how well patients recover after surgery.

Most of the time, grafts from a patient or a donor are pretty similar to a healthy rotator cuff in terms of how much weight they can bear and how stiff they are. Synthetic grafts can bear a similar amount of weight as a healthy tendon, but aren’t as stiff. Grafts from cell matrices are less able to bear weight and are less stiff compared to a healthy rotator cuff.

Despite these differences, the results of using a graft repair for large, unrepairable rotator cuff tears are promising. According to the data from two years after surgery, patients report improved function and there are few complications or failures of the repair, regardless of what type of graft is used.

FAQs

  1. What are the different types of graft materials that can be used for interposition repairs of massive irreparable rotator cuff tears?
  2. How do the various graft materials compare biomechanically to intact rotator cuff tendons?
  3. What have been the reported outcomes and complications of interposition graft repairs after two years post-surgery?

Doctor’s Tip

One helpful tip a doctor might give a patient about rotator cuff repair is to follow a thorough rehabilitation program post-surgery to ensure optimal healing and strength in the shoulder. This may include physical therapy exercises to improve range of motion, strengthen the muscles surrounding the rotator cuff, and prevent stiffness or weakness in the shoulder. It is important to follow the guidance of your healthcare provider and physical therapist to ensure a successful recovery and long-term function of the shoulder.

Suitable For

Patients who are typically recommended for rotator cuff repair are those with massive irreparable rotator cuff tears. These tears are usually seen in older patients with significant degeneration of the rotator cuff tendons, leading to a large defect that cannot be repaired using traditional techniques. Patients with significant pain, weakness, and limited range of motion in the shoulder are often candidates for rotator cuff repair surgery. It is important for patients to undergo a thorough evaluation by a orthopedic surgeon to determine if they are a good candidate for surgery and to discuss the potential risks and benefits of the procedure.

Timeline

Before rotator cuff repair, a patient may experience pain, weakness, limited range of motion, and difficulty performing daily activities due to the rotator cuff tear. They may undergo conservative treatments such as physical therapy, cortisone injections, and anti-inflammatory medications to manage symptoms. If these treatments are unsuccessful, surgery may be recommended.

After rotator cuff repair, the patient will typically undergo a period of rehabilitation to restore strength and range of motion in the shoulder. This may involve physical therapy, exercises, and activity modification. The patient will gradually increase their activity level and return to normal function over several months. In some cases, full recovery may take up to a year. Studies have shown promising outcomes in patient-reported functional outcomes after interposition graft repairs of massive irreparable rotator cuff tears, with few reported complications or repair failures at 2 years post-surgery.

What to Ask Your Doctor

  1. What is the specific type of graft material that will be used for my rotator cuff repair?

  2. How does this graft material compare biomechanically to intact rotator cuff tendons?

  3. What are the expected outcomes of interposition graft repair for my massive irreparable rotator cuff tear?

  4. Are there any potential complications or risks associated with using this particular graft material for my surgery?

  5. What is the expected recovery time and rehabilitation process following the rotator cuff repair surgery?

  6. How long can I expect the results of the interposition graft repair to last?

  7. Are there any alternative treatment options to consider for my massive irreparable rotator cuff tear?

  8. How many of these types of surgeries have you performed, and what is your success rate with this procedure?

  9. What can I do to optimize my recovery and ensure the best possible outcome from the rotator cuff repair surgery?

  10. Are there any specific lifestyle modifications or precautions I should take following the surgery to prevent re-injury or complications?

Reference

Authors: Sunwoo JY, Murrell GAC. Journal: J Am Acad Orthop Surg. 2020 Oct 1;28(19):e829-e838. doi: 10.5435/JAAOS-D-19-00500. PMID: 32649438