Study Shows Improved Mobility in Rotator Cuff Repairs Using Allograft
Suffering from terrible pain, Stefan Maul was unable to move his right shoulder. During the first attempt to repair his shoulder, Maul was told his rotator cuff tear was too severe to repair. But, a visit to orthopedic surgeon Marc R. Labbé, MD at St. Luke’s Episcopal Hospital (St. Luke’s) revived Maul’s hope for mobility.
The rotator cuff is a group of four muscles and tendons that help control the ball within the socket of the shoulder during activity. A tear of one or more of these tendons disrupts this activity which can lead to severe pain and weakness in the shoulder, especially with overhead activity. Patients often notice pain at night as well. According to the American Academy of Orthopaedic Surgeons, close to two million people in the United States visited physicians in 2008 because of a rotator cuff issue. Rotator cuff tears are increasingly common with advancing age.
Nearly seven years ago, Labbé developed a novel technique to add a soft tissue graft to the repair site with hopes of strengthening the repair and increasing the chances of healing. Beginning as a standard rotator cuff repair, the cuff tear is fixed in the standard fashion and the graft is then added. Not all tears are candidates for the graft. The need for the graft is based upon several factors including the size and age of the tear and whether or not there was previous surgery. Recently, a revolutionary study has determined that the grafting procedure does help. This study utilizes the GraftJacket matrix, a three-dimensional human dermal tissue, to augment the repair. The graft material is donor human skin that has been tested and prepared to remove the cellular material but maintain the internal architecture. No anti-rejection medications are needed. The graft provides initial mechanical strength to the repair and then becomes incorporated and replaced with native tissue.
The level one study indicates that the GraftJacket offers an effective treatment option for large rotator cuff tears and enhances the likelihood of complete healing. Patients included in the study were between the ages of 18 and 75 with large rotator cuff tears measuring at least three centimeters in width and two tendon involvement which could be repaired arthroscopically. The graft was also applied arthroscopically. Postoperatively, patients involved in the study were placed in an abduction sling for four to six weeks, allowing daily pendulum motion exercises. Supervised physical therapy was started at four weeks with strengthening allowed starting at 12 weeks.
“I had to pick up my right hand with my left hand,” Maul recounts. A retired butcher and resident of Magnolia, Maul has long suffered from neck and back injuries as well as carpal tunnel syndrome making him familiar with pain. After being told in the recovery room that the tear was not repairable, Maul visited Labbé the following day and underwent the allograft repair a week later.
Over a year since his surgery with Labbé, Maul enjoys playing ping-pong and pool as well as working out. “It is a miracle. The pain in my shoulder is now a one to zero. If my back and neck were like my shoulder, I could run a marathon!” explained Maul.
Debbie “Jo” McMains, a resident of Crosby, experienced an accident prone year from 2009 to 2010 as she underwent a procedure by Labbé for a rotator cuff repair. An administrative secretary with St. Luke’s, McMains immediately visited Labbé when she injured her shoulder. After learning how severe her tear was, Labbé recommended grafting the repair.
“Dr. Labbé fixed me! I continue doing the things I love to do.” McMains explains following her successful procedure late last year. With help of the allograft she has regained full motion in her shoulder and “feels fantastic.”
In most standard repairs, the rate of recurrent tearing or incomplete healing averages 25 percent. In larger tears the numbers jump to between 40 and 90 percent. Eighty-five percent of patients who underwent the allograft augmented repair demonstrated intact cuffs 12 months following surgery compared to 40 percent of patients who underwent a standard repair. No adverse events related to the graft were observed.
“I initially developed the procedure to try to rescue failed repairs. About five years ago Dr. Taylor Brown, joined our group and learned the technique. Over the years, we have modified the technique and expanded my indications to include those tears that have a high likelihood of failure adding the graft at the initial procedure. Our patients have responded very well and now there is good data to support our personal results. Surgeons are now able to strengthen what is usually the weakest link in a cuff repair, the tissue. While this is not a cure-all, I believe that we are just at the beginning of developing the potential for this technology,” explains Labbé.
For more information on this study or rotator cuff treatment options, contact The Bone and Joint Clinic of Houston.