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Interposition Patches for Massive Rotator Cuff Tears: Helpful or Not? A Prospective Study of 164 Interposition
James Bilbrough1, Ala Hawa1,2, Mina Shenouda1
1Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia.
Background:
It is undetermined how well interposition polytetrafluoroethylene (PTFE) patch repairs for massive and irreparable rotator cuff tears perform in the longer term and whether the procedure can prevent proximal humeral migration, glenohumeral arthritis, and conversion to reverse total shoulder arthroplasty.
Purpose:
To answer the following questions: (1) Do interposition PTFE patch repairs inserted for massive and irreparable rotator cuff tears improve patient pain and function, shoulder strength, and range of motion? (2) How long do interposition PTFE patches last? (3) Do interposition PTFE patches prevent proximal humeral migration and glenohumeral arthritis? (4) Do interposition PTFE patches prevent patient conversion to reverse total shoulder arthroplasty?
Study Design:
Case series; Level of evidence, 4.
Methods:
We conducted a prospective cohort study of 164 consecutive patients with interposition PTFE patch repairs for massive and irreparable rotator cuff tears, with a median follow-up time of 26 months. Patient-reported pain and function, shoulder strength, and range of motion were assessed preoperatively, at 6 months postoperatively, and at the final follow-up. Ultrasound was used to assess PTFE patch integrity at 6 months postoperatively and at the final follow-up, and shoulder radiographs were taken at 6 months postoperatively and at the final follow-up. Kaplan-Meier survival analysis was used.
Results:
Patients with intact PTFE patches on ultrasound had greater improvements in pain and function, strength, and range of motion at the final follow-up (median, 26 months; range, 6 months to 19 years) when compared with patients with nonintact PTFE patches (P < .05). Of 164 interposition PTFE patches, 50 (30%) functionally failed at a median time of 5 years. In the whole cohort, Kaplan-Meier analysis estimated that the median survivorship time of these PTFE patches was 7.4 years. Furthermore, patients with intact interposition PTFE patches demonstrated a 21% lower severity of glenohumeral arthritis (P = .03) and a 46% lower incidence of proximal humeral migration (P < .001) than patients with nonintact interposition PTFE patches. At the final follow-up, 93% of participants were free from conversion to reverse total shoulder arthroplasty after interposition PTFE patch repair for a massive and irreparable rotator cuff tear.
Conclusion:
Based on the results of this study, interposition PTFE patch repairs for massive and irreparable rotator cuff tears were efficacious at improving patients' pain and function, strength, and range of motion. Patients with intact interposition PTFE patches were associated with reduced severity of glenohumeral arthritis and reduced incidence of proximal humeral migration. At the final follow-up, 93% of participants were free from conversion to reverse total shoulder arthroplasty.
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