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Repair technique using a Dacron ligament shows efficacy for massive rotator cuff tears

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SAN FRANCISCO — A novel surgical technique that involves partially covering the humeral head with a Dacron ligament can improve pain and range of motion in patients who have massive rotator cuff tears, according to a study presented here.

Atif Nada, MBBCh, LRCP, MRCS, FRCS, MPhil, and colleagues at Nevill Hall Hospital in Abergavenny, United Kingdom, conducted the prospective study, which investigated the clinical outcomes for 25 patients treated at a mean age of 69.3 years.

They displayed their results in a poster at the American Academy of Orthopaedic Surgeons 75th Annual Meeting.

All patients had MRI evidence of massive rotator cuff tears and painfully restricted range of shoulder movement. Surgeons performed the novel Dacron ligament repair technique after arthroscopically confirming the presence of a full-thickness rotator cuff tear and atrophy.

The technique involves passing a Dacron ligament percutaneously through a modified portal of Neviaser, "medial to the tear through the healthy cuff tissue," the authors wrote.

Next, the ends of the ligament that straddle the tear are passed through tunnels in the proximal humerus at the supraspinatus tendon insertion. The ligament is then tied on the outside of the humerus, and the periphery of the edges are sutured "as close as possible," according to the study.

At 1-year mean follow-up, all patients were pain free and had significant improvements in shoulder function.

At follow-up, shoulder flexion averaged –65° to 124°, and shoulder abduction averaged –60° to 120° (P<.01). The mean Constant score significantly improved, from 36.5 points preoperatively to 76.3 points after the procedure (P<.001). Scores for activities of daily living also improved, from 9.6 points preoperatively to 16.8 points at follow-up (P<.001), according to the study.

"Overall patient satisfaction scores were 95%," the authors noted.

"This new technique of reconstruction produces consistent and lasting pain relief with improvement in the [range of motion] in the elderly population who has significant disability due to massive rotator cuff tears," they wrote.

For more information:

• Nada A, Debnath UK, Rogers C. Dacron ligament augmentation of massive rotator cuff tear. Poster P313. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.