Bridging repair reinforced with artificial ligament as an internal brace for irreparable massive rotator cuff tears

BACKGROUND:The irreparable massive rotator cuff tear (IMRCT) is challenging to manage. Although various surgical options have been proposed to treat IMRCTs, the optimal surgical technique remains controversial. Arthroscopic bridging patch repair is clinically used for treating IMRCTs，but the healing rate of the patch graft is negatively affected by superior shift of the humeral head. This study aimed to evaluate the clinical efficacy of artificial ligament as an internal brace (IB) reinforcing fascia lata autograft bridging repair (ABR) in the treatment of IMRCTs. METHODS:The data of 50 patients with IMRCTs who underwent ABR reinforced with artificial ligament as an IB (ABR + IB) (internal brace group) or ABR alone (control group) were retrospectively evaluated preoperatively and at 2-year follow-up. Clinical outcomes were assessed based on the shoulder activity, of which the strength was measured using a 0-10 points manual muscle test scale, American Shoulder and Elbow Surgeons (ASES) Score, and visual analog scale (VAS) for pain. Imaging outcomes were evaluated based on acromiohumeral distance (AHD), Hamada grade, Goutallier grade, and the status of fascia lata grafts according to radiographs or magnetic resonance imaging findings. RESULTS:Both groups showed significantly better results in shoulder activity, ASES score, VAS, and AHD at 2-year follow-up compared with preoperative levels (P < 0.001). Compared with the control group (n = 24), the internal brace group (n = 26) had better mean AHD (7.0 ± 1.4 mm versus 5.9 ± 1.0 mm, P = 0.002), mean improvement in AHD (3.3 ± 1.5 mm versus 2.0 ± 0.6 mm, P < 0.001), healing rate of autografts (92.3% versus 54.2%, P = 0.002), and improvement rate of Hamada grade (73.1% versus 41.7%, P = 0.025) at 2-year follow-up. No significant differences were found in active elevation, active external rotation, active internal rotation, abduction strength, external rotation strength, internal rotation strength, ASES score, or VAS between the two groups at 2-year follow-up CONCLUSION: Both the ABR + IB and ABR improved the postoperative short-term clinical and imaging outcomes in managing IMRCTs, the ABR + IB is statistically superior to ABR alone in terms of healing rate of the bridging graft, AHD, and Hamada grade at 2-year follow-up, while further clinical investigations with larger sample size and longer follow-ups are required to validate the clinical significance of this novel technique for IMRCTs.