Treatment of massive and recurrent rotator cuff tears augmented with a poly-l-lactide graft, a preliminary study.

BACKGROUND: The incidence of failed rotator cuff repairs remains high, especially in the setting of massive tears or revision repairs. The purpose of this study was to evaluate patient outcomes and repair integrity after augmentation with the repair patch, a poly-l-lactide synthetic polymer. METHODS: Sixteen consecutive patients with massive or recurrent rotator cuff tears underwent open repair with synthetic poly-l-lactide patch augmentation. Two patients required the patch to bridge defects, and 1 patient retore after a motor vehicle accident and had revision surgery at another institution. The 13 remaining patients were retrospectively evaluated from 1.2 to 1.7 years (average, 1.5 years) after surgery by PENN, American Shoulder and Elbow Surgeons, and Single Assessment Numeric Evaluation scores. Magnetic resonance imaging was used to examine the integrity of the repair at a minimum of 1 year of follow-up. RESULTS: The mean age was 57.3 years (42-68 years). Five patients (38%) had an intact rotator cuff at the time of follow-up. The remaining patients (62%) had full-thickness tears. PENN scores significantly improved from a preoperative score of 50.9 to 77.6 (P < .005). American Shoulder and Elbow Surgeons scores significantly improved from 32.8 to 74.2 (P = .0001). Single Assessment Numeric Evaluation scores at latest follow-up were 76.2. CONCLUSION: Poly-l-lactide repair patch augmentation of massive and recurrent large to massive rotator cuff tears demonstrates significant improvement in shoulder outcome measures for this difficult population, despite a retear rate of 62%. Further investigation with larger, prospective long-term studies is needed to determine whether this technique provides a true benefit compared with traditional, nonaugmented repair.

Heat generated with pegged or keeled glenoid components fixed with defined amounts of cement.

Glenoid component loosening is a common complication of total shoulder arthroplasty and has been associated with the progression of radiolucent lines at the glenoid bone-cement interface. Generation of heat during the exothermic reaction of cement curing may cause osteonecrosis of bone, potentially leading to the development of radiolucent lines. The purpose of this study was to measure the heat generated with various defined amounts of cement used for glenoid component fixation.Ten fresh-frozen cadaver scapulas were randomized to receive a keeled or pegged component with 1, 2, 3, 5, or 7 g of cement for fixation. An infrared camera was used to record the surface temperature generated during the cement curing process to an accuracy of ±2.0°C. Computed tomography was used to evaluate the cement mantle. The maximum temperatures generated did not exceed the critical value for osteonecrosis (56°C) in any of the specimens. The 4 specimens without a complete mantle were those fixed with a smaller quantity of cement (1, 2, or 3 g), and the largest cement mantle thicknesses were observed with the use of 7 g of cement.Up to 7 g of cement can be used without significant concern for thermal necrosis. Incomplete cement mantles were observed when ≤3 g of cement was used for fixation. Our results suggest that surgeons should use >3 g of cement to avoid incomplete cement mantles and that up to 7 g of cement can safely be used for glenoid fixation.