A Comparison of Clinical Outcomes in Rotator Cuff Re-Tear Patients Who Had Either an Arthroscopic Primary Repair or Arthroscopic Patch Augmentation for Large-to-Massive Rotator Cuff Tears

Abstract

Background and purpose: Despite the prevalent incidence of re-tear following rotator cuff repair, there is a notable lack of comparative studies investigating the outcomes between patients with re-tear who underwent primary repair versus those who received patch augmentation for large-to-massive tears. We assessed clinical outcomes of these techniques through a retrospective, randomized controlled trial.

Methods: 134 patients diagnosed with large-to-massive rotator cuff tears from 2018 to 2021 underwent surgery; 65 had primary repair and 69 had patch augmentation. A total of 31 patients with re-tears were included, split into two groups; Group A (primary repair, 12 patients) and Group B (patch augmentation, 19 patients). Outcomes were evaluated using several clinical scales and MRI imaging.

Results: Most clinical scores improved postoperatively in both groups. No significant difference in clinical outcomes was observed between groups, except for pain visual analog scale (P-VAS) scores. P-VAS scores showed greater decrease in the patch-augmentation group, a statistically significant difference.

Conclusions: for large-to-massive rotator cuff tears, patch augmentation led to greater decreases in pain than primary repair, despite similar radiographic and clinical results. Greater tuberosity coverage of the supraspinatus tendon footprint may impact P-VAS scores.

Keywords: allograft; patch; revision; rotator cuff; shoulder arthroscopy.

Figure 1

Flow chart of study participant recruitment. Recruitment criteria and the selection process are illustrated. MRI—magnetic resonance imaging. f/u—follow up.

Figure 2

Arthroscopic views and MRIs of re-tear patient. (A) Patch augmentation using human allograft for a large rotator cuff tear. (B) Postoperative MRI shows a well-maintained patch graft covering GT footprint (arrow). (C) Second-look arthroscopic view. A re-tear can be identified, and GT-covering fibrotic tissue can also be seen. (D) A T2-weighted coronal image of the right shoulder from a pre-second-operation MRI reveals a major discontinuity (a Sugaya Grade V re-tear) of the supraspinatus tendon. A fibrosis remnant of the allograft patch covers the GT footprint area (arrowhead) despite the re-tear. MRI—magnetic resonance imaging; GT—greater tuberosity.