title: Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade fatty degeneration of the infraspinatus: patch autograft procedure versus partial repair procedure.
abstract: OBJECTIVE
  This study aimed to compare the arthroscopic patch graft procedure and partial repair for irreparable large or massive rotator cuff tears (RCTs) in shoulders with low-grade fatty degeneration of the infraspinatus (stage 1 or 2 according to Goutallier et al.) in terms of the functional and structural outcomes.
  
  
  METHODS
  This study included 24 patients who underwent the patch graft procedure (group A) and 24 patients who underwent partial repair (group B) for irreparable large or massive RCTs. Clinical outcomes were evaluated at a mean of 35.5 months postoperatively in group A and 35.7 months in group B.
  
  
  RESULTS
  The clinical findings were significantly improved at the final follow-up in both groups (P < .001). A significant difference was found between groups A and B in terms of postoperative Constant and American Shoulder and Elbow Surgeons scores (P = .001 and P = .021, respectively). There was a significant difference in the retear rate for the infraspinatus tendon (ISP) between the 2 groups (2 patients [8.3%] in group A v 10 patients [41.7%] in group B, P = .015). At the final follow-up, there was a significant difference in the affected side-versus-unaffected side muscle strength ratios for abduction and external rotation between group A and group B (P < .001 for both). Shoulders with retears of the ISP showed significantly inferior clinical outcomes compared with those without retears (P < .001).
  
  
  CONCLUSIONS
  In arthroscopic surgery for irreparable large or massive RCTs with low-grade fatty degeneration of the infraspinatus, the patch graft procedure showed an 8.3% retear rate for the repaired ISP with both improved clinical scores and recovery of muscle strength, whereas the partial repair had a retear rate of 41.7% (P = .015).
  
  
  METHODS
  Level Ш, retrospective comparative study.
authors.affiliation: Kyoto Shimogamo Hospital, Kyoto, Japan. Electronic address: altair.0421@gmail.com.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Mori
authors.forename: Noboru
authors.initials: N
authors.lastname: Funakoshi
authors.forename: Fumiharu
authors.initials: F
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D064592:Autografts; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000150:complications / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D053580:Muscle Strength; D016017:Odds Ratio; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000473:pathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D055502:Secondary Prevention; D012785:Shoulder Joint / Q000473:pathology / Q000503:physiopathology; D020069:Shoulder Pain / Q000209:etiology; D053656:Tenodesis / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome