Massive rotator cuff tears with short tendon length can be successfully repaired using synthetic patch augmentation.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomaterials in Medicine

Background:

• Massive rotator cuff tears (MRCTs) present a significant surgical challenge, particularly when good muscle quality is present with limited tendon length.
• Nonaugmented repairs in such cases have high failure rates, exceeding 90%.

Purpose of the Study:

• To evaluate the midterm clinical and radiologic outcomes of MRCTs with good muscle quality and short tendon length repaired using synthetic patch augmentation.

Main Methods:

• A retrospective study analyzed patients with MRCTs (Goutallier ≤ II, tendon length <15 mm) who underwent patch augmentation between 2016-2019.
• Clinical outcomes (Constant-Murley score, Subjective Shoulder Value, range of motion) and structural integrity (MRI) were assessed at a minimum 2-year follow-up.
• Exclusion criteria included age >75 years and Hamada stage ≥2a rotator cuff arthropathy.

Main Results:

• Significant improvements were observed in Constant-Murley score (absolute and relative), Subjective Shoulder Value, and forward flexion (P < .05).
• The retear rate was 53%, with 3 clinical failures requiring reoperation.
• Importantly, partial reruptures did not correlate with inferior functional outcomes compared to intact repairs.

Conclusions:

• Synthetic patch augmentation demonstrates significant functional and structural benefits for specific MRCT cases.
• Partial reruptures after patch augmentation do not necessarily lead to poorer functional results.
• Further validation through prospective randomized trials is recommended.