Download PDF
CC BY-NC-ND 4.0 · Joints 2018; 06(03): 135-140
DOI: 10.1055/s-0038-1676106
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Porcine Dermal Xenograft as Augmentation in the Treatment of Large Rotator Cuff Tears: Clinical and Magnetic Resonance Results at 2-Year Follow-Up

Alessandro Castagna
1   Center for Shoulder and Elbow Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Eugenio Cesari
2   Shoulder Surgery Unit, Humanitas Gavazzeni Institute, Bergamo, Italy
,
Berardo Di Matteo
3   Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
4   Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Marcello Osimani
5   Department of Radiological Sciences, University of Rome “Sapienza,” ICOT, Latina, Italy
,
Raffaele Garofalo
6   Upper Limb Unit, F. Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
,
Elizaveta Kon
3   Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
4   Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Maurilio Marcacci
3   Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
4   Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Claudio Chillemi
7   Department of Othopaedics and Traumatology – Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
› Author Affiliations Funding None.
Further Information

Publication History

16 May 2018

20 October 2018

Publication Date:
12 December 2018 (online)

   Permissions and Reprints

Abstract

Purpose The aim of the present retrospective study is to describe the results obtained at 2-year follow-up by using a porcine dermis-derived collagen membrane implanted as augmentation to treat large rotator cuff tears.

Methods Thirty-five patients in total were included according to the following criteria: large or massive rotator cuff tear, confirmed during surgery, measuring between 3 and 5 cm in width and stage 1 to 2 fatty infiltration documented at magnetic resonance imaging (MRI). Patients underwent arthroscopic repair of the cuff augmented by the implantation of a porcine dermal collagen membrane. Patients were evaluated up to 24 months after surgery by the Constant score and MRI imaging to assess functional outcomes and re-tear rate. The results obtained were compared to those of a matched cohort of 35 patients operated by arthroscopic repair alone by the same surgical team.

Results The application of the porcine membrane proved to be safe without scaffold-related adverse events documented. A statistically significant difference in the Constant score in favor of the treatment group was documented at the final evaluation (p = 0.036). Furthermore, a subgroup analysis revealed that patients treated by augmentation and presenting re-tear at MRI showed a significantly higher functional outcome compared with control patients with MRI evidence of re-tear (p = 0.0136).

Conclusion Arthroscopic repair augmented by porcine dermal xenograft for the treatment of chronic and retracted rotator cuff tears with low-grade fatty degeneration proved to be safe and also effective, with higher functional score compared with the arthroscopic repair alone.

Level of Evidence This is a Level III, retrospective cohort study.

Keywords

rotator cuff - massive tear - scaffold - dermal collagen membrane - augmentation

Note

All the data, due to privacy reasons, will be available upon motivated request to the corresponding author of the present article.


 

  • References

  • 1 Davidson PA, Rivenburgh DW. Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elbow Surg 2000; 9 (06) 502-506
    CrossrefPubMedSearch in Google Scholar
  • 2 Matthews TJ, Hand GC, Rees JL, Athanasou NA, Carr AJ. Pathology of the torn rotator cuff tendon. Reduction in potential for repair as tear size increases. J Bone Joint Surg Br 2006; 88 (04) 489-495
    PubMedSearch in Google Scholar
  • 3 Chillemi C, Petrozza V, Garro L. , et al. Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1588-1596
    CrossrefPubMedSearch in Google Scholar
  • 4 Harryman II DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen III FA. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 1991; 73 (07) 982-989
    CrossrefPubMedSearch in Google Scholar
  • 5 Mura N, O'Driscoll SW, Zobitz ME, Heers G, An KN. Biomechanical effect of patch graft for large rotator cuff tears: a cadaver study. Clin Orthop Relat Res 2003; (415) 131-138
    PubMedSearch in Google Scholar
  • 6 Ozaki J, Fujimoto S, Masuhara K, Tamai S, Yoshimoto S. Reconstruction of chronic massive rotator cuff tears with synthetic materials. Clin Orthop Relat Res 1986; (202) 173-183
    PubMedSearch in Google Scholar
  • 7 Neviaser JS. Ruptures of the rotator cuff of the shoulder. New concepts in the diagnosis and operative treatment of chronic ruptures. Arch Surg 1971; 102 (05) 483-485
    PubMedSearch in Google Scholar
  • 8 Baker AR, McCarron JA, Tan CD, Iannotti JP, Derwin KA. Does augmentation with a reinforced fascia patch improve rotator cuff repair outcomes?. Clin Orthop Relat Res 2012; 470 (09) 2513-2521
    CrossrefPubMedSearch in Google Scholar
  • 9 Neviaser JS, Neviaser RJ, Neviaser TJ. The repair of chronic massive ruptures of the rotator cuff of the shoulder by use of a freeze-dried rotator cuff. J Bone Joint Surg Am 1978; 60 (05) 681-684
    CrossrefPubMedSearch in Google Scholar
  • 10 Moore DR, Cain EL, Schwartz ML, Clancy Jr WG. Allograft reconstruction for massive, irreparable rotator cuff tears. Am J Sports Med 2006; 34 (03) 392-396
    CrossrefPubMedSearch in Google Scholar
  • 11 Jarman-Smith ML, Bodamyali T, Stevens C, Howell JA, Horrocks M, Chaudhuri JB. Porcine collagen crosslinking, degradation and its capability for fibroblast adhesion and proliferation. J Mater Sci Mater Med 2004; 15 (08) 925-932
    CrossrefPubMedSearch in Google Scholar
  • 12 Adedeji OA, Bailey CA, Varma JS. Porcine dermal collagen graft in abdominal-wall reconstruction. Br J Plast Surg 2002; 55 (01) 85-86
    CrossrefPubMedSearch in Google Scholar
  • 13 Barrington JW, Dyer R, Bano F. Bladder augmentation using Pelvicol implant for intractable overactive bladder syndrome. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (01) 50-53
    CrossrefPubMedSearch in Google Scholar
  • 14 Liyanage SH, Purohit GS, Frye JN. , et al. Anterior abdominal wall reconstruction with a Permacol implant. J Plast Reconstr Aesthet Surg 2006; 59 (05) 553-555
    CrossrefPubMedSearch in Google Scholar
  • 15 Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 2003; 12 (06) 550-554
    CrossrefPubMedSearch in Google Scholar
  • 16 Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999; 8 (06) 599-605
    CrossrefPubMedSearch in Google Scholar
  • 17 Dejardin LM, Arnoczky SP, Ewers BJ, Haut RC, Clarke RB. Tissue-engineered rotator cuff tendon using porcine small intestine submucosa. Histologic and mechanical evaluation in dogs. Am J Sports Med 2001; 29 (02) 175-184
    CrossrefPubMedSearch in Google Scholar
  • 18 Chillemi C, El Boustany S, Dei Giudici L, Ippolito G. Arthroscopic rotator cuff repair with augmentation: the V-sled technique. Orthop Surg 2012; 4 (02) 109-113
    CrossrefPubMedSearch in Google Scholar
  • 19 Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aärimaa V. Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg 2013; 22 (12) 1650-1655
    CrossrefPubMedSearch in Google Scholar
  • 20 Sclamberg SG, Tibone JE, Itamura JM, Kasraeian S. Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa. J Shoulder Elbow Surg 2004; 13 (05) 538-541
    CrossrefPubMedSearch in Google Scholar
  • 21 Zalavras CG, Gardocki R, Huang E, Stevanovic M, Hedman T, Tibone J. Reconstruction of large rotator cuff tendon defects with porcine small intestinal submucosa in an animal model. J Shoulder Elbow Surg 2006; 15 (02) 224-231
    CrossrefPubMedSearch in Google Scholar
  • 22 Russell RD, Knight JR, Mulligan E, Khazzam MS. Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Joint Surg Am 2014; 96 (04) 265-271
    CrossrefPubMedSearch in Google Scholar
  • 23 Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med 2012; 40 (10) 2248-2255
    CrossrefPubMedSearch in Google Scholar
  • 24 Nho SJ, Delos D, Yadav H. , et al. Biomechanical and biologic augmentation for the treatment of massive rotator cuff tears. Am J Sports Med 2010; 38 (03) 619-629
    CrossrefPubMedSearch in Google Scholar
  • 25 Badhe SP, Lawrence TM, Smith FD, Lunn PG. An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elbow Surg 2008; 17 (1, Suppl): 35S-39S
    CrossrefPubMedSearch in Google Scholar
  • 26 Mori D, Funakoshi N, Yamashita F. Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade fatty degeneration of the infraspinatus: patch autograft procedure versus partial repair procedure. Arthroscopy 2013; 29 (12) 1911-1921
    CrossrefPubMedSearch in Google Scholar
  • 27 Gupta AK, Hug K, Boggess B, Gavigan M, Toth AP. Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis: clinical and radiographic outcomes of reconstruction using dermal tissue matrix xenograft. Am J Sports Med 2013; 41 (04) 872-879
    CrossrefPubMedSearch in Google Scholar
  • 28 Ciampi P, Scotti C, Nonis A. , et al. The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study. Am J Sports Med 2014; 42 (05) 1169-1175
    CrossrefPubMedSearch in Google Scholar
  • 29 Barber FA, Burns JP, Deutsch A, Labbé MR, Litchfield RB. A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthroscopy 2012; 28 (01) 8-15
    CrossrefPubMedSearch in Google Scholar
  • 30 Bond JL, Dopirak RM, Higgins J, Burns J, Snyder SJ. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy 2008; 24 (04) 403-409
    PubMedSearch in Google Scholar
  • 31 Derwin KA, Baker AR, Spragg RK, Leigh DR, Iannotti JP. Commercial extracellular matrix scaffolds for rotator cuff tendon repair. Biomechanical, biochemical, and cellular properties. J Bone Joint Surg Am 2006; 88 (12) 2665-2672
    CrossrefPubMedSearch in Google Scholar
  • 32 Barber FA, Herbert MA, Coons DA. Tendon augmentation grafts: biomechanical failure loads and failure patterns. Arthroscopy 2006; 22 (05) 534-538
    CrossrefPubMedSearch in Google Scholar
  • 33 Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ. Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. J Bone Joint Surg Am 2006; 88 (06) 1238-1244
    CrossrefPubMedSearch in Google Scholar
  • 34 Phipatanakul WP, Petersen SA. Porcine small intestine submucosa xenograft augmentation in repair of massive rotator cuff tears. Am J Orthop 2009; 38 (11) 572-575
    PubMedSearch in Google Scholar
  • 35 Shea KP, McCarthy MB, Ledgard F, Arciero C, Chowaniec D, Mazzocca AD. Human tendon cell response to 7 commercially available extracellular matrix materials: an in vitro study. Arthroscopy 2010; 26 (09) 1181-1188
    CrossrefPubMedSearch in Google Scholar
  • 36 Nicholson GP, Breur GJ, Van Sickle D, Yao JQ, Kim J, Blanchard CR. Evaluation of a cross-linked acellular porcine dermal patch for rotator cuff repair augmentation in an ovine model. J Shoulder Elbow Surg 2007; 16 (5, Suppl): S184-S190
    CrossrefPubMedSearch in Google Scholar
  • 37 Malcarney HL, Bonar F, Murrell GA. Early inflammatory reaction after rotator cuff repair with a porcine small intestine submucosal implant: a report of 4 cases. Am J Sports Med 2005; 33 (06) 907-911
    CrossrefPubMedSearch in Google Scholar