title: Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial.
abstract: BACKGROUND
  Evidence to justify the use of porcine small intestine submucosa to augment repairs of large and massive rotator cuff tears is based on favorable results found in studies of Achilles tendon and infraspinatus tendon repairs in canines. The purpose of this study was to determine the effectiveness of a small intestine submucosal patch to augment the repair of chronic two-tendon rotator cuff tears in humans.
  
  
  METHODS
  Thirty shoulders with a chronic two-tendon rotator cuff tear that was completely repairable with open surgery were randomized to be treated with either augmentation with porcine small intestine mucosa or no augmentation. All patients completed a PENN shoulder-score questionnaire preoperatively and at the time of the latest follow-up (at an average of fourteen months). Magnetic resonance imaging showed that nine shoulders had a large tear and twenty-one had a massive tear. All patients underwent a magnetic resonance imaging scan with intra-articular gadolinium one year after the repair to assess the status of the rotator cuff.
  
  
  RESULTS
  The rotator cuff healed in four of the fifteen shoulders in the augmentation group compared with nine of the fifteen in the control group (p = 0.11). The median postoperative PENN total score was 83 points in the augmentation group compared with 91 points in the control group (p = 0.07). Healing of the defects in both groups demonstrated a strong correlation with the patients' clinical scores. The median postoperative PENN total score was 96 points in the group with a healed repair and 81 points in the group with a failed repair (p = 0.007). The percentage change between the preoperative and postoperative patient satisfaction scores was 400% in the group with a healed repair, and 50% in the group with a failed repair (p = 0.04).
  
  
  CONCLUSIONS
  Augmentation of the surgical repair of large and massive chronic rotator cuff tears with porcine small intestine submucosa did not improve the rate of tendon-healing or the clinical outcome scores. On the basis of these data, we do not recommend using porcine small intestine submucosa to augment repairs of massive chronic rotator cuff tears done with the surgical and postoperative procedures described in this study.
authors.affiliation: Department of Orthopaedic Surgery A-41, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. iannotj@ccf.org
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Iannotti
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Codsi
authors.forename: Young W
authors.initials: YW
authors.lastname: Kwon
authors.forename: Kathleen
authors.initials: K
authors.lastname: Derwin
authors.forename: James
authors.initials: J
authors.lastname: Ciccone
authors.forename: John J
authors.initials: JJ
authors.lastname: Brems
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D019643:Arthroplasty, Replacement; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D020127:Recovery of Function / Q000502:physiology; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D013552:Swine; D017211:Treatment Failure