Management of irreparable rotator cuff tears is challenging and controversial. Surgeons have been utilising biological tissue scaffolding to augment repairs, but there are concerns regarding viability and function. We wished to investigate this viability and clinical outcome in a small group of patients.

All procedures were performed by a single surgeon over a three-year period. Inclusion criteria were patients with large cuff tears and failure of non-operative treatment. Exclusion criteria were patients with glenohumeral arthritis and where cuff repair could not be successfully performed. Open rotator cuff repair followed by augmentation with Graft Jacket® Regenerative Tissue Matrix (Wright Medical) was performed in all patients. A structured cuff repair physiotherapy protocol was then followed. Follow-up was at six months and at minimum twenty-four months post-operatively where Constant scores (CS) and Oxford Shoulder scores (OSS) were noted and a repeat ultrasound performed.

Fourteen patients underwent the procedure. No patient was lost to follow-up. There were seven males and seven females with a mean age of 63 years (range 31–77). At minimum twenty-four month follow-up, thirteen patients had flexion and abduction above 90 degrees and symmetrical external rotation. Mean CS was 81 (range 70–91) and mean OSS was 46 (range 41–48). Shoulder ultrasound revealed an intact Graft Jacket® in all thirteen patients. The final patient had lower functional movement and lower CS (34) and OSS (25) and ultrasound identified a re-rupture.

This study indicates that augmentation of large rotator cuff repairs with biological tissue scaffolding is a viable option and has good functional results.

Summary

Strong mechanical fixation is critical to the success of rotator cuff repairs. In this comparative study in cadaveric shoulders, single-tendon full-thickness supraspinatus tears were repaired using two different types of PEEK knotless suture anchors-ReelX STT (Stryker) and Opus Magnum PI (Arthrocare)-using a single-row technique in both instances. Cyclic testing was performed followed by loading until mechanical failure. No significant difference was observed in gap formation, measured as the distance between the supraspinatus tendon and bone at the repair site, during cyclic loading. However, the maximum load was statistically higher for repairs with the ReelX anchor.