title: Employment of synthetic patch with augmentation of the long head of the biceps tendon in irreparable lesions of the rotator cuff: our technique applied to 60 patients.
abstract: BACKGROUND
  The aim of our study was to evaluate the effectiveness of both clinical and functional benefits after the surgical repair of the rotator cuff in irreparable lesions using a synthetic patch with augmentation of the long head of the biceps (LHB) tendon.
  
  
  METHODS
  This is a retrospective study analysis of a randomized series of 60 patients (45 women and 15 men; average age 66 y) who underwent open repair of irreparable rotator cuff tear with synthetic patch using LHB tendon augmentation between 1999 and 2008.The inclusion criteria were: patients painful symptomatology, presenting a deficit in elevation, who are not responsive to physiotherapy, irreparable tear size, minimum follow-up of 36 months after surgery, and active and motivated patients. We used a control group of 60 patients treated without employment of the synthetic patch and LHB tendon augmentation.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. All the patients were assessed preoperatively also with plain radiographs (anteroposterior and axillary views), ultrasound, and NMRI of the shoulder. The VAS and UCLA scores were also obtained 3 months postoperatively. Tendon integrity was assessed after 1 year by NMRI. Statistical analysis was conducted by 1-way analysis of variance between groups of treatment, with Dunnett post hoc correction for multiple comparisons. P-values ≤ 0.05 were considered as statistically significant. This surgical technique consisted in a short deltoid splitting, irreparable lesion evaluation, and, after tenodesis, the proximal segment of the LHB tendon was sutured to the remaining cuff tendons to fill the gap of the corresponding lesion. To shield the repaired rotator cuff we inserted a synthetic patch.
  
  
  RESULTS
  Satisfactory results were achieved in 52 of the patients treated with this procedure; after 3 months the mean VAS was 6.85 ± 1.11 versus 4.9 ± 0.9, whereas the mean UCLA was 11.28 ± 1.43 versus 20.85 ± 1.27, respectively, for control and prolene group. After 36 months the mean VAS was 3.7 ± 1.01 versus 3.23 ± 1.07, whereas the mean UCLA was 14.73 ± 1.96 versus 24.6 ± 3.3, respectively, for control and prolene group. In addition, after 36 months elevation on the scapular plane was 140.75 ± 10.48 degrees versus 174.75 ± 8.1 degrees and abduction strength was 8.57 kg ± 0.63 versus 13.61 kg ± 0.84, respectively, for control and prolene group (P-value = 0.005). Re-tear rate after 12 months was 40% (24/60) in the control group and 15% (9/60) in the prolene group. No adverse side effects (infection, rejection, allergy) were reported during the study period.
  
  
  CONCLUSIONS
  The results of our study suggest that employing this surgical technique in patients (appropriately selected) with an irreparable rotator cuff tear can lead to pain relief and improved clinical outcome.
authors.affiliation: Orthopedics and Traumatology Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Vitali
authors.forename: Andrea
authors.initials: A
authors.lastname: Cusumano
authors.forename: Alberto
authors.initials: A
authors.lastname: Pedretti
authors.forename: Nadim
authors.initials: N
authors.lastname: Naim Rodriguez
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Fraschini
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D011126:Polypropylenes; D019736:Prostheses and Implants; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D053656:Tenodesis / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes