Surgical repair of large-to-massive rotator cuff tears seems to be a better option than patch augmentation or débridement and biceps tenotomy: a prospective comparative study

J Shoulder Elbow Surg. 2018 Sep;27(9):1545-1552. doi: 10.1016/j.jse.2018.05.023. Epub 2018 Jul 3.


Background: This prospective study compared the outcomes after 3 different treatments for large and massive rotator cuff tears.

Methods: Patients with a diagnosis of large-to-massive rotator cuff tears were prospectively included. Patients were allocated in 3 groups: (1) arthroscopic complete repair (repair group), (2) open repair and xenograft patch augmentation (patch group), and (3) arthroscopic débridement and tenotomy of the long head of the biceps (débridement group). Patients were evaluated preoperatively and postoperatively at 3, 6, 12 and 24 months. The primary outcome measure was the Constant-Murley score.

Results: The study included 32 consecutive patients. The mean improvement in the Constant-Murley score was +29.1 for the repair group (P < .01), +32.2 for the patch group (P < .01), and +20.1 for the débridement group (P < .01) at the final follow-up examination. No differences were found between the repair and patch groups, but the difference became significant between the débridement group and the patch group (P < .001) and also between the débridement group and the repair group (P < .002) at 12 months and the final follow-up. Moreover, 5 complications occurred in 11 patients in the patch group, whereas there was only 1 complication in the repair group and no complications in the débridement group.

Conclusion: The use of porcine dermis patches to augment repairs of massive and irreparable rotator cuff tears is not recommended because there is no benefit compared with repair without augmentation and patches result in more complications.

Keywords: Massive rotator cuff; arthroscopic; débridement; healing; histology; patch; repair.

Publication types

  • Comparative Study

MeSH terms

  • Acellular Dermis*
  • Aged
  • Arthroscopy*
  • Debridement*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal / surgery*
  • Prospective Studies
  • Rotator Cuff Injuries / pathology
  • Rotator Cuff Injuries / surgery*
  • Tenotomy*
  • Treatment Outcome