Dasari Suhas P, Fortier Luc M, Bodendorfer Blake M, DeFroda Steven F, Cole Brian J, Verma Nikhil N
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Video J Sports Med. 2022 Mar 8;2(2):26350254211058738. doi: 10.1177/26350254211058738. eCollection 2022 Mar-Apr.
Rotator cuff repair using graft augmentation for large-to-massive, full-thickness rotator cuff tears has been reported to have improved clinical outcomes relative to other therapeutic interventions. Although an effective and promising technique, graft augmentation can be technically challenging, particularly with deployment and positioning of the graft. CuffMend is a user-friendly rotator cuff augmentation technique that combines a decellularized dermal allograft with a novel graft deployment device, tendon anchor, and set of lateral knotless, tension-able anchors to allow for a reliable and stable implantation of the graft.
Graft augmentation using CuffMend is indicated for tears with a high risk of retear or incomplete healing. This includes revision tears, poor-quality degenerative tissue, and massive full-thickness rotator cuff tears. Severe glenohumeral osteoarthritic change is the primary contraindication to this technique.
The rotator cuff is reduced medially and secured using 3 anchors with sutures passed in a mattress configuration. Graft augmentation is then performed using the CuffMend graft spreader that facilitates placement and attachment of the graft onto the repaired tendon.
The patient is recovering as expected and started physical therapy 1 month postoperatively. He is able to perform light activities of daily living and reach the top of his head for daily self-care without pain. He will begin strengthening at 12 weeks postoperatively.
DISCUSSION/CONCLUSION: CuffMend is a new graft augmentation technique that uses a novel graft deployment device for consistent and precise deployment of a decellularized dermal allograft. This facilitates an expedited repair using the graft augmentation technique for optimal clinical and biomechanical outcomes in patients with rotator cuff tears with high risk of retear.
据报道，对于大型至巨大型、全层肩袖撕裂，使用移植物增强进行肩袖修复相对于其他治疗干预措施，临床效果有所改善。尽管移植物增强是一种有效且有前景的技术，但在技术上可能具有挑战性，尤其是移植物的展开和定位。CuffMend是一种用户友好的肩袖增强技术，它将脱细胞真皮同种异体移植物与新型移植物展开装置、肌腱锚钉以及一组外侧无结、可张紧的锚钉相结合，以实现移植物的可靠稳定植入。
使用CuffMend进行移植物增强适用于再撕裂风险高或愈合不完全的撕裂。这包括翻修撕裂、质量差的退变组织以及巨大型全层肩袖撕裂。严重的盂肱关节骨关节炎改变是该技术的主要禁忌症。
将肩袖向内侧复位，使用3个锚钉并以褥式缝合固定。然后使用CuffMend移植物撑开器进行移植物增强，该撑开器有助于将移植物放置并附着到修复的肌腱上。
患者按预期恢复，术后1个月开始物理治疗。他能够进行轻度日常生活活动，并且在日常自我护理时能够无痛地触及头顶。他将在术后12周开始进行强化锻炼。
讨论/结论：CuffMend是一种新的移植物增强技术，它使用新型移植物展开装置来一致且精确地展开脱细胞真皮同种异体移植物。这有助于使用移植物增强技术进行快速修复，从而为再撕裂风险高的肩袖撕裂患者带来最佳的临床和生物力学效果。
