Reconstruction of Massive Rotator Cuff Tear with Modified Debeyre's Method in Combination with a Fascia Lata Patch: Clinical Results in 3 Patients

Abstract

Objective: Every treatment method for massive rotator cuff tear has some disadvantages. The authors applied modified Debeyre's method in combination with fascia lata patch grafting in order to achieve satisfactory results.
Subjects and Method: Three shoulders of 3 patients received surgery with this procedure. At surgery, torn end was at first freed from surrounding tissues according to the McLaughlin procedure. Modified Debeyre's method (supra-and infra-spinatus muscles are freed from the scapula and advanced) was applied to patients whose torn end were unable to be drawn to proximal to the greater tuberosity of humerus with the arm at the side. Then, for 3 patients whose torn ends after the advancement were still unable to be drawn to proximal to the greater tuberosity, autologous fascia lata patch was grafted. The 3 patients' clinical findings were evaluated by using the Japan Orthopaedic Association score (JOA score) before surgery, one year after surgery and at the last examination (24, 41, or 43 months) . Conditions of reconstructed rotator cuff were also examined on MR images before and 2 years after surgery.
Results: The fascia lata patch successfully covered the torn part up to the insertion point of greater tuberosity. The average JOA score improved from 58 (range: 49-71.5) before surgery to 82 (73-95) one year later and 83 (73-97) at the final examination. Two shoulders had maintained the continuity of the reconstructed tendon, but one shoulder had partial re-tear.
Conclusion: Modified Debeyre's method that makes supra- and infra-spinatus muscles advance is an excellent technique, and supplemental application of autologous fascia lata to the cases of insufficiently advanced tendon was thought to be useful.