Rotator Cuff Repair with Graft Augmentation
Why might a graft be needed for rotator cuff repair?
While the majority of rotator cuff tears heal successfully following surgical repair, some large or "massive" tears are less likely to heal with conventional repair alone. The same is true for recurrent tears - those rotator cuff injuries that tear again after an initial surgical repair. In these unusual cases, one promising new treatment option involves placing a graft over the repair to "augment" or strengthen the repair construct and increase the chances for success. Similar to sewing a patch over a repaired hole in your jeans, implanting a graft over an otherwise tenuous rotator cuff repair increases the strength of the construct and the likelihood that the repair will heal.
As seen on this MRI of a normal shoulder, the rotator cuff muscle transitions into tendon (black portion) as it runs toward its insertion on the humeral head.
In this example of a "massive" rotator cuff tear, the tendons have pulled away from the normal rotator cuff insertion site on the humerus and retracted a relatively long distance. In order to repair the tendon, it must be secured back to the insertion site on the humerus, as shown by the course of the dotted orange arrow. Such repairs are prone to failure. In these rare cases, augmenting the repair with the addition of a graft has been shown to improve healing rates.
How is the graft put in the shoulder?
Rotator cuff grafts can be implanted either through an open incision, or minimally invasively using advanced arthroscopic techniques. Dr. Driscoll is one of few surgeons to work directly with the pioneers of the arthroscopic rotator cuff grafting techniques. This is the method that he prefers, as it allows for an excellent repair while minimizing post-operative pain and damage to the surrounding shoulder tissues.
Where do the grafts come from?
The grafts used for rotator cuff repair are human dermal allografts. This means that the grafts are from the dermis (skin) of human donors. The tissue is processed to remove all cells, but to retain its mechanical strength and microscopic architecture. The result is a very strong scaffold that is capable of reinforcing the repair, but that retains a framework for vascular ingrowth and repopulation with the patient’s own cells.
Allografts are used commonly in orthopedic surgery for ACL reconstruction, cartilage restoration, and other surgical procedures. Graft processing is regulated by the American Association of Tissue Banks (AATB) and the Food and Drug Administration’s (FDA). Careful donor screening, laboratory testing, and graft preparation minimize the risk of disease transmission and immune reaction. For more information, see the graft manufacturer websites: Wright Medical or Musculoskeletal Transplant Foundation.
What is the recovery period like?
Arthroscopic rotator cuff repair with graft augmentation is an outpatient surgery. Patients go home the same day with a shoulder immobilizer sling. The sling is worn for about 6 weeks, but may be removed for bathing and work on a computer. Patients are allowed to return to most light activities by 6 months after surgery. The return to more strenuous activities progresses at a gradual pace due to the nature of these large tears and the time that it takes for the graft to become integrated into the native rotator cuff. Full clinical recovery may take up to a year.