Biologic Augmentation in RC Repair (Patches and Grafts): Part II
Rotator cuff tears are common problems among middle age and older adults that can result in significant morbidity. While many patients do well after rotator cuff repair, there is still a high percentage of patients with recurrent tearing of their rotator
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Kristi Hultman, Brandon J. Erickson, Meghan E. Bishop, and Anthony A. Romeo
41.1 Introduction Rotator cuff tears are a common problem among middle age and older adults that can result in significant morbidity. Shoulder pain accounts for over 4.5 million doctor visits per year in the United States, with rotator cuff pathology as the leading cause [1]. Current studies suggest the prevalence of rotator cuff abnormalities in symptomatic shoulders is 40% in adults 40–50 years old, between 61% and 68% in adults 50–80 years old, and 50% in adults over 80 years old [2]. As our population continues to age, the number of patients requiring treatment will increase. Current standard of care for a symptomatic rotator cuff tear is either an open or arthroscopic repair of the torn tendons with sutures and anchors in a variety of configurations, although there is a role for conservative treatment alone in certain patients. Certain rotator cuff tears, such as acute on chronic tears, partial-thickness tears, etc., can be treated with conservative measures including therapy and steroid injections. Unfortunately approximately half of those K. Hultman Rothman Institute, Philadelphia, PA, USA e-mail: [email protected] B. J. Erickson · M. E. Bishop · A. A. Romeo (*) Rothman Institute, New York, NY, USA e-mail: [email protected]; [email protected]; anthony. [email protected]
patients will have tear progression that can result in worsening pain and disability, often necessitating operative intervention at a later point in time. Rotator cuff tear progression is associated with smoking, male sex, hand dominance, trauma, age, fatty infiltration, medium- to large-sized tears, and full-thickness tears. These tears have been shown to progress at an average rate of 2 mm/year in width and 3.8 mm/year in length [3, 4]. Surgical repair of the rotator cuff is recommended for younger patients, laborers who have acute or traumatic tears and larger tears, or patients that have failed conservative treatment [4]. Despite advances in surgical techniques and technology, current literature shows retearing of the rotator cuff in approximately 25% of patients within the first 2–5 years following surgical treatment, with an even higher percentage of retears seen in larger rotator cuff tears [5–7].
41.2 Tendon Healing Considering the relatively high rate of failure for rotator cuff repairs, it is important to examine the biology behind the tendon-to-bone healing process to better understand how it can be improved. Predisposing factors known to contribute to poor healing capacity and that carry a greater risk for retearing include tear size, tear chronicity, patient age, smoking status, tendon and muscle quality, and fatty infiltration or muscle atrophy [4, 8].
© ISAKOS 2019 A. B. Imhoff, F. H. Savoie III (eds.), Rotator Cuff Across the Life Span, https://doi.org/10.1007/978-3-662-58729-4_41
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Fig. 41.1 Four zones of the tendon-to-bone interface. Zone 1 is the tendinous region c
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