Abstract
Purpose: We conducted a prospective preliminary study of ten cases of surgical repair of massive rotator cuff tears using a free quadriceps bone-tendon transplant. All procedures were performed between May 1998 and May 2000.
Material and methods: The series included seven men and three women (mean age 51 years 9 months). The dominant limb was involved in nine cases. Six of the patients were working. Mean duration of symptoms was 15 months (6–36 months). Mean preoperative Constant score was 49.1/100 points. The three most frequent signs were daily pain, limited amplitude, and loss of force. A MRI was obtained in nine cases and an arthroscan in one. There was a full-thickness tear of the rotator cuff with proximal retraction in eight cases and intermediary retraction in two. Fatty degneration (Goutallier-Bernageau) was basically grade II for the supraspinatus, and grade III for the infraspinatus. At MRI the tear measured more than 16 cm2. Acromioplasty was performed in all cases, tenotomy and long-biceps tenodesis in seven. Sutures were made with Mersuture n° 2 using the Mason-Allen technique along the tear contour. The superficial portion of the quatriceps tendon was harvested via a longitudinal prepatellar incision. The quadriceps tendon was harvested with the trapezoidal patellar bony attachement. The free quadriceps tendon flap was sutured to the borders of the cuff and a bony tunnel was made to impact the bony attachment. Postoperative immobilisation was achieved with an abduction sling and a removable flexion brace for the knee. All patients participated in the centre’s rehabilitation programme and were reviewed at consultation. An MRI was obtained for five patients with the longest follow-up.
Results: Mean follow-up was 18 months. Mean Constant score at last follow-up was greater than 70 points. Mean force was less than 5 kg. The MRI obtained in five cases demonstrated a normal tendon with no signs of necrosis. There was one tear of the quadriceps tendon at the knee. This patient experienced persistent fatigability at 12 months.
Discussion: Treatment of full-thickness tears of the rotator cuff remains problematic, particularly in young active patients. Acromioplasty and bursectomy only provide pain relief. There is an ascension of the humeral head with an excentrated scapula. Classical transosseous reinsertion is not possible when there is major retraction. Certain teams advance the supraspinatus and the infraspinatus. Deltoid flaps only provide pain relief by their interposition in the subacromial space. Tendon transfer using the rectus is highly invasive and difficult to perform. The quadriceps tendon transplant is resistant and integrates perfectly in this reconstruction.
Conclusion: Repair of massive full-thickness rotator cuff tears in young patients with limited fatty degeneration remains a difficult challenge. For these patients, we propose repair using a free quadriceps bone-tendon transplant.
The abstracts were prepared by Pr. Jean-Pierre Courpied (General Secretary). Correspondence should be addressed to him at SOFCOT, 56 rue Boissonade, 75014 Paris, France
