2000 Volume 24 Issue 3 Pages 357-361
We used to graft tensor fascia lata for massive rotator cuff tears. But restoration of external rotation strength was not so good. Then from 1996 we have performed an infraspinatus tendon repair in addition to a patch graft. We report on its operative technique and the results. Ten shoulders of 10 patients were evaluated. The average age was 59.1 years old. The average followup period was 23 months. All shoulders had atrophy of the infraspinatus. In MRI T2 weighted axial images high intensity of the infraspinatus was found in all the shoulders. The opearative technique: in the lateral decubitus position, a saber cut incision was made. The deltoid was detached from the acromion. The avulsion of the the infraspinatus tendon insertion was often recognized and this tendon tear site was covered by a membranous tissue. This membranous tissue was cut off and the infraspinatus tendon is exposed and repaired to a bone trough. Supraspinatus tendon defect was closed with a fascia lata patch graft. Postoperative program: In the first 2 weeks the shoulder was immobilized with a sling and swathe. Passive elevation exercises were started at 2 weeks and active elevation exercises were begun at 4 weeks.
A patch graft rupture occurred in 2 patients. These 2 patients had a patch graft again and a latissimus dorsi transfer. The preoperative average JOA score was 58 points and the postoperative one was 82points. There were 4 patients with excellent results,3 with good results,1 with a fair result and 2 with poor results. The strength of external rotation was improved in 8 shoulders. In 6 months postoperative MRI T2 weighted axial image low intensity of the infraspinatus was found in 7 shoulders. We recommend an infraspinatus tendon repair to restore the external rotation strength for massive rotator cuff tears.
