Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis: clinical and radiographic outcomes of reconstruction using dermal tissue matrix xenograft.

BACKGROUND: The management of irreparable massive or full-thickness 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis remains a difficult challenge for the treating surgeon. Many different treatment options, with varied success, have been proposed. HYPOTHESES: (1) Patients undergoing reconstruction of irreparable massive or full-thickness 2-tendon rotator cuff tears by dermal tissue matrix xenograft would demonstrate improvements in pain, range of motion, strength, and subjective functional outcomes. (2) Postoperative ultrasonography would demonstrate intact repairs at a minimum 2-year follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty-six patients (27 shoulders) underwent reconstruction of irreparable massive or full-thickness 2-tendon rotator cuff tears by dermal tissue matrix xenograft. Pain level (scale 0-10, 10 = severe pain), active range of motion, and supraspinatus and external rotation strength were assessed. Subjective outcome measures included American Shoulder and Elbow Score (ASES) and Short Form-12 (SF-12) score. Clinical and radiographic analyses were performed at an average 32-month follow-up period (minimum 2-year follow-up). Ultrasound imaging (static and dynamic) of the operative shoulder was performed at final follow-up to assess the integrity of the construct. RESULTS: Mean patient age was 60 years. Mean pain level decreased from 5.1 to 0.4 (P = .002). Mean active forward flexion and abduction improved from 138.8° to 167.3° (P = .024) and 117.9° to 149.3° (P = .001), respectively. Supraspinatus and external rotation strength improved from 7.2 to 9.4 (P = .001) and 7.4 to 9.5 (P = .001), respectively. Mean ASES improved from 62.7 to 91.8 (P = .0007), and mean SF-12 scores improved from 48.4 to 56.6 (P = .044). Twenty-one patients (22 shoulders) returned for a dynamic and static ultrasound of the operative shoulder at a minimum 2-year follow-up. Sixteen patients (73%) demonstrated a fully intact tendon-graft reconstruction, 5 patients (22%) had a partially intact reconstruction, and 1(5%) had a complete tear at the graft-bone interface caused by suture anchor pullout as a result of a fall. There were no cases of infection or tissue rejection. CONCLUSION: Active patients with massive or 2-tendon rotator cuff tears with minimal glenohumeral arthritis continue to be a subset of the population for whom there is no current standard of care. Results suggest that the use of porcine xenograft may be an effective means by which to treat these patients.

Dermal tissue allograft for the repair of massive irreparable rotator cuff tears.

BACKGROUND: Massive irreparable rotator cuff tears in patients without advanced glenohumeral arthritis can pose a challenge to surgeons. Numerous management strategies have been utilized, and studies have shown varied results with regard to shoulder pain, range of motion, strength, and overall function. HYPOTHESIS: Patients undergoing repair of massive irreparable rotator cuff tears through a mini-open approach with the use of human dermal tissue matrix allograft would demonstrate an improvement in pain, range of motion, strength, and subjective functional outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We performed a prospective observational study of 24 patients who underwent interposition repair of massive rotator cuff tears using human dermal allograft. All patients were evaluated preoperatively and postoperatively by the treating surgeon. Data were collected preoperatively and postoperatively for an average 3-year follow-up period (range, 29-40 months). Active range of motion as well as supraspinatus and infraspinatus strength was assessed. Subjective outcome measures included pain level (visual analog scale of 0-10, with 10 = severe pain), American Shoulder and Elbow Score (ASES), and Short-Form 12 (SF-12) score. Imaging evaluation to assess for repair integrity was performed using static and dynamic ultrasonography at final follow-up. RESULTS: Mean pain level decreased from 5.4 to 0.9 (P = .0002). Mean active forward flexion and external rotation motion improved from 111.7° to 157.3° (P = .0002) and from 46.2° to 65.1° (P = .001), respectively. Mean shoulder abduction improved from 105.0° to 151.7° (P = .0001). Supraspinatus and infraspinatus strength improved from 7.2 to 9.4 (P = .0003) and from 7.8 to 9.3 (P = .002), respectively. Mean ASES improved from 66.6 to 88.7 (P = .0003). Mean SF-12 scores improved from 48.8 to 56.8 (P = .03). One partial graft retear occurred because of patient noncompliance during postoperative rehabilitation. However, this patient still demonstrated improvement in pain, motion, and subjective outcomes at final follow-up. Ultrasonography demonstrated "fully intact" repairs in 76% of patients. All remaining patients had "partially intact" repairs. There were no complete tears. CONCLUSION: In our series of carefully selected candidates, all patients demonstrated a significant improvement in pain, range of motion, and strength. Subjective outcome measures, including mean ASES and SF-12 scores, also demonstrated significant improvement at an average 3-year follow-up.

Assessing communication between oncology professionals and their patients.

BACKGROUND: Effective communication with cancer patients continues to be an elusive goal for health care professionals (HCPs) and cancer educators. METHODS: We posted a survey on the ConversationsInCare.com Web site to collect information from oncology HCPs regarding attitudes, effectiveness, and specific patient communication skills. RESULTS: The 291 respondents agreed that good communication enhances patient satisfaction (76%) and treatment compliance (88%). Only 34% of respondents felt comfortable discussing complementary or alternative therapies, and approximately half of all respondents felt they lack the skills to help patients maintain hope. CONCLUSIONS: Oncology HCPs believe that good communication is important and wish to improve their skills. Implications for cancer educators are discussed.