Reports from the orthopaedic field stress that surgical repair of massive rotator cuff tears plus revision rotator cuff repair pose as a major challenge in the orthopaedic field. This explains the common failure rates registered in the previous years.
Currently, rotator cuff repair augmentation with the help of patches (either synthetic or biological in nature) is seen as an effective approach to improve repair (surgical) expertize, most especially in patients with a poor tendon quality.
In the past, until the present, treating massive rotator cuff tears has been performed through debridement, partial repair, plus arthroscopic subacromial decompression. In addition, techniques like joint prosthesis, muscle-tendon transfer, to mention but a few are utilized.
According to orthopaedic surgeons, each surgical approach is associated with its own advantages, but in patients with massive rotator cuff tears, the results were notably low.
With that, the arthroscopic patch graft procedure was considered to be an effective surgical procedure after disregarding the primary repair. During this surgical approach, suture anchors are utilized to fix the patch graft to the footprint on the side of the greater tuberosity (tuberosities).
The Latest Surgical Approach For Massive Rotator Cuff Repair
To improve the surgical outcomes various biological patches are taking their root. These include; human skin, swine small intestinal mucous membrane, autologous fascia lata femoris, and bovine skin. The utilization of these types of patches is expected to facilitate patch strengthening.
Additional benefits include;
- Provision of a bridge for cellular ingrowth to improve the biological environment
- Providing early strength
- Preventing rejection
- Faster healing process
The Surgery Process & Patch Grafting
The arthroscopic patch graft procedure is performed under general anaesthesia. This form of Arthoroscopy surgery in India is conducted in the beach-chair lateral-traction position to allow the surgeon use of the traction.
The procedure highly involves synovectomy and debridement of the degenerated acetabular labrum and biceps tendon and the rotator cuff stump was dissected with the help of bursoscopy. The stump was then held with a gasper and later on pulled out toward the greater tuberosity to determine whether the repair should be performed or not.
In case the primary repair wasn’t possible, patch grafting is rendered the last option. The procedure is as follows;
- Tears are initially repaired in case present in the subscapularis and infraspinatus tendons. Partial repair was seen as the main approach in this case.
- The size of the internal-external and anterior-posterior was determined at the end of the partial repair.
- The relay sutures for introducing the graft ligament into the joint space were then prepared. These include four prolene sutures which are placed in the stump of the remaining cuff.
- Depending on the size determined, the iliotibial ligament with bone are collected. Different concerns are followed during this step after which the graft is formed.
- Once formed, it is then introduced into the joint alongside the Prolene sutures. Anchor portal and the rest of the bones are fixed.