title: The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study.
abstract: BACKGROUND
  Rotator cuff repair typically results in a satisfactory, although variable, clinical outcome. However, anatomic failure of the repaired tendon often occurs.
  
  
  OBJECTIVE
  Patch augmentation can improve the results of open rotator cuff repair by supporting the healing process, protecting the suture, and reducing friction in the subacromial space.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  A total of 152 patients with a posterosuperior massive rotator cuff tear were treated by open repair only (control group; n = 51; mean age, 67.06 ± 4.42 years), open repair together with collagen patch augmentation (collagen group; n = 49; mean age, 66.53 ± 5.17 years), or open repair together with polypropylene patch augmentation (polypropylene group; n = 52; mean age, 66.17 ± 5.44 years) and were retrospectively studied. Patients were evaluated preoperatively and after 36 months with a visual analog scale (VAS) and the University of California, Los Angeles (UCLA) shoulder rating scale and by measuring elevation of the scapular plane and strength with a dynamometer. The VAS and UCLA scores were also obtained 2 months postoperatively. Tendon integrity was assessed after 1 year by ultrasound. Patients were homogeneous as per the preoperative assessment.
  
  
  RESULTS
  After 2 months, results (mean ± standard deviation) for the control, collagen, and polypropylene groups, respectively, were as follows: VAS scores were 6.96 ± 1.11, 6.46 ± 1.02, and 4.92 ± 0.90, while UCLA scores were 11.29 ± 1.46, 11.40 ± 1.51, and 19.15 ± 1.99. After 36 months, the mean scores for the respective groups were 3.66 ± 1.05, 4.06 ± 1.02, and 3.28 ± 1.10 for the VAS and 14.88 ± 1.98, 14.69 ± 1.99, and 24.61 ± 3.22 for the UCLA scale. In addition, after 36 months, elevation on the scapular plane was 140.68° ± 9.84°, 140.61° ± 12.48°, and 174.71° ± 8.18°, and abduction strength was 8.73 ± 0.54 kg, 9.03 ± 0.60 kg, and 13.79 ± 0.64 kg for the control, collagen, and polypropylene groups, respectively. The retear rate after 12 months was 41% (21/51) for the control group, 51% (25/49) for the collagen group, and 17% (9/52) for the polypropylene group. In particular, the reduced 12-month retear rate and the increased UCLA scores, abduction strength, and elevation at 3-year follow-up were statistically significant for patients treated with a polypropylene patch compared with those treated with repair only or with a collagen patch.
  
  
  CONCLUSIONS
  Polypropylene patch augmentation of rotator cuff repair was demonstrated to significantly improve the 36-month outcome in terms of function, strength, and retear rate.
authors.affiliation: Giuseppe M. Peretti, Department of Biomedical Sciences for Health, University of Milan, Via R. Galeazzi 4, 20161 Milan, Italy. gperetti@iol.it and Gianfranco Fraschini, Department of Orthopaedics and Traumatology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy (e-mail: fraschini.gianfranco@hsr.it).
authors.forename: Pietro
authors.initials: P
authors.lastname: Ciampi
authors.forename: Celeste
authors.initials: C
authors.lastname: Scotti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nonis
authors.forename: Matteo
authors.initials: M
authors.lastname: Vitali
authors.forename: Clelia
authors.initials: C
authors.lastname: Di Serio
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Peretti
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Fraschini
mesh_terms: D000367:Age Factors; D000368:Aged; D001705:Bioprosthesis; D016022:Case-Control Studies; D003094:Collagen; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D053580:Muscle Strength; D010496:Pericardium; D011126:Polypropylenes; D012008:Recurrence; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000601:surgery; D013526:Surgical Mesh; D064232:Visual Analog Scale
chemical_list: D011126:Polypropylenes; D003094:Collagen
keywords: augmentation; open repair; patch; rotator cuff tear