This retrospective case series evaluated arthroscopic medialized single-row repair augmented with autologous fascia lata graft in 45 patients with large or massive rotator cuff tears too retracted for primary repair. It asked whether the graft lowers the retear rate, and compared clinical outcomes between patients whose repairs stayed intact and those who retorn.
When a large or massive cuff tear is too retracted to reach the footprint, you have a menu: medialize and repair, augment, bridge, do superior capsule reconstruction, or go to reverse arthroplasty. This paper stakes out the middle option, medialized single-row repair reinforced with an autologous fascia lata graft, for tears that can still be primarily repaired after medializing the footprint.
The practical lesson is that outcome tracks structural integrity. Intact repairs gained motion and strength; retears essentially did not improve on ROM or strength. Remember the tradeoff of medialization: it offloads tension but costs motion, roughly 17° of abduction and 11° of external rotation at 10 mm, and healing rates drop past 10 mm. Keep medialization modest.
Read the result honestly. The retear rate looks better than historical controls, but this is a Level IV single-arm series with no comparison group, and the score differences between intact and retorn shoulders were below the MCID.
This retrospective case series evaluated arthroscopic medialized single-row repair augmented with autologous fascia lata graft in 45 patients with large or massive rotator cuff tears too retracted for primary repair. It asked whether the graft lowers the retear rate, and compared clinical outcomes between patients whose repairs stayed intact and those who retorn.
When a large or massive cuff tear is too retracted to reach the footprint, you have a menu: medialize and repair, augment, bridge, do superior capsule reconstruction, or go to reverse arthroplasty. This paper stakes out the middle option, medialized single-row repair reinforced with an autologous fascia lata graft, for tears that can still be primarily repaired after medializing the footprint.
The practical lesson is that outcome tracks structural integrity. Intact repairs gained motion and strength; retears essentially did not improve on ROM or strength. Remember the tradeoff of medialization: it offloads tension but costs motion, roughly 17° of abduction and 11° of external rotation at 10 mm, and healing rates drop past 10 mm. Keep medialization modest.
Read the result honestly. The retear rate looks better than historical controls, but this is a Level IV single-arm series with no comparison group, and the score differences between intact and retorn shoulders were below the MCID.