title: Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device.
abstract: BACKGROUND
  Rotator cuff repair is a procedure with varying outcomes, and there has been subsequent interest in devices that reinforce the repair and enhance structural and functional outcomes. The objective of this study was to determine these outcomes for arthroscopic repair of large and massive rotator cuff tears augmented with a synthetic absorbable mesh designed specifically for reinforcement of tendon repair by imaging and clinical assessments.
  
  
  METHODS
  Consecutive arthroscopic repairs were performed on 18 patients with large to massive rotator cuff tears by use of a poly-l-lactic acid synthetic patch as a reinforcement device and fixation with 4 sutures. Patients were assessed preoperatively and at 6 months, 12 months, and a mean of 42 months after surgery by the American Shoulder and Elbow Surgeons (ASES) shoulder score to evaluate clinical performance and at 12 months by ultrasound to assess structural repair.
  
  
  RESULTS
  Ultrasound showed that 15 of 18 patients had intact rotator cuff repair at 12 months; at 42 months, an additional patient had a failed repair. Patients showed improvement in the ASES shoulder score from 25 preoperatively to 71 at 12 months and 70 at 42 months after surgery. Patients with intact rotator cuff (n = 14) at 42 months had an ASES shoulder score of 82.
  
  
  CONCLUSIONS
  The poly-l-lactic acid bioabsorbable patch designed specifically to reinforce the surgical repair of tendons supported successful repair of large to massive rotator cuff tears in 83% of patients at 12 months after surgery and 78% of patients at 42 months after surgery, with substantial functional improvement.
authors.affiliation: Alta Orthopedics, Santa Barbara, CA, USA. Electronic address: chris@proctor.net.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Proctor
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D006801:Humans; D019344:Lactic Acid; D008875:Middle Aged; D011091:Polyesters; D011108:Polymers; D019919:Prosthesis Implantation; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012782:Shoulder / Q000601:surgery; D013526:Surgical Mesh; D013708:Tendon Injuries / Q000601:surgery*; D014945:Wound Healing
chemical_list: D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)
keywords: Rotator cuff tear; arthroscopic reconstruction; augmentation; bioabsorbable; graft; reinforcement; synthetic