Free coracoacromial ligament graft for augmentation of massive rotator cuff tears treated with mini-open repair

Objectives: Repair of massive rotator cuff tears is a challenging and complex procedure. The tis¬sue at the end of the torn tendons is often friable and weak, because ruptures are old and degen¬erated, and thus the ends must be sutured effectively and strongly to achieve a satisfactory out¬come. We aimed to evaluate the effectiveness of free total or partial coracoacromial ligament (CAL) graft to protect and augment the repair of massive rotator cuff tears. Methods: Forty six patients ((32 females, mean age 54.3 years (range 39-66 years)) operated for massive rotator cuff tears between January 2003 and June 2009 were included in the study. Twenty nine of these patients had right-sided tears, and 17 had left-sided tears. Fifteen of the tears were 3-4 cm wide (mean 3.5 cm); 27 were >4 cm wide (mean 4.5 cm), and 4 were >5 cm wide. The mean follow-up period was 26 months (range 16-52 months). Patients were operated with a mini-open technique, and reconstructed after primary repair with 18 total and 28 partial free trans¬fer of the CAL. Patients were evaluated by Constant-Murley score, and the degree of active flex¬ion and abduction. Tendon thickness was measured with ultrasonography during follow-up. Results: Mean preoperative shoulder flexion was 27.5° (range 5-40°), and mean abduction was 22.5° (range 10-30°). Shoulder flexion was significantly greater postoperatively (mean 102.6°, range 70-150°), as was shoulder abduction (mean 96.5°, range 60-150°). Mean preoperative and postoperative Constant-Murley score was 45 and 80, respectively. Surgical complications, par¬ticularly recurrence, did not occur in any patient during the follow-up period. The integrity and tendon thickness of the repairs were similar to those of normal tendons at the end of follow-up. Conclusion: Augmentation with a free transfer of the coracoacromial ligament provides excel¬lent and promising functional results in the operative treatment of massive rotator cuff tears with a mini-open technique.