No healing improvement after rotator cuff reconstruction augmented with an autologous periosteal flap
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To show descriptive clinical and magnetic resonance (MR) imaging results after an additional periosteal flap augmentation in mini-open rotator cuff reconstruction and to evaluate potential healing improvement at long-term follow-up.
Twenty-three patients with degenerative rotator cuff tears were followed after receiving a mini-open single-row repair with a subtendinous periosteal flap augmentation. Data were collected preoperatively, after 12 months and after 11 years. Clinical examination, simple shoulder test (SST), Constant–Murley Score (CS), ultrasonography examination and 3T MR imaging were performed.
Out of 23 patients, 20 were available for short-term and 19 for final follow-up at a median of 11.5 years (range 10.4–13.0). Questions answered with “yes” in SST improved from baseline 5.0 (range 1.0–8.0) to short 10.5 (range 8.0–12.0) and final follow-up 12.0 (range 7.0–12.0). CS improved from 53.5 (range 25.0–66.0) to 80.8 (range 75.9–89.3) and finally to 79.8 points (range 42.3–95.4). Improvement was highly significant (p < 0.05). Severe retears were found in 9/19 patients. Ossifications along the refixed tendon were noticed in 8/19 cases. Ossifications did not correlate with clinical outcome. At final follow-up, patients with retears seemed likely to have lower strength values in CS (mean ± SD) than patients without retears (7.3 ± 4.1 vs. 12.8 ± 5.3; p < 0.05).
No positive effect on improving healing response in rotator cuff refixation with a periosteal flap augmentation could be found. Retear rate is comparable to that of conventional rotator cuff refixation in the published literature. Ossifications along the tendon, without negatively affecting the clinical outcome, were seen. This invasive technique cannot be advised and should not be used anymore.
Level of evidence
KeywordsRotator cuff repair Rotator cuff healing Periosteal flap Tendon augmentation
No one of the authors has received personal financial support related to this study.
Compliance with ethical standards
Conflict of interest
Authors C. Holwein, B. von Bibra, P. M. Jungmann, D. C. Karampinos, K. Wörtler, M. Scheibel declare that they have no conflict of interest. Author A. B. Imhoff is a consultant for Arthrosurface, Arthrex, and mediBayreuth. Author S. Buchmann is a consultant for Arthrex.
The study was granted approval by Ethics Commission School of Medicine Technical University of Munich with the related number 70/15s.
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