Today, let's look at a case where a rotator cuff tear was so old that anatomical restoration wasn't possible, and an artificial tendon (allomend) was used to achieve anatomical restoration. A 66-year-old female patient had long-standing shoulder pain but had only been managing it with injections when it hurt. Empty can test was positive and significant muscle weakness was noted. Let's check the X-ray.
Given the clinical and X-ray findings strongly suggesting a rotator cuff tear, MRI was performed.
In such cases, the rotator cuff should be restored to the greater tuberosity of the humerus, but there's a high chance it won't reach. The surgical plan was to perform maximum repair and augment any irreparable portion with an artificial tendon (allomend).
Surgery was performed as planned, with rotator cuff repair and augmentation using allomend. Post-operative MRI was taken to confirm results.
MRI was taken again at 3 months post-surgery.
In cases of massive rotator cuff tears, complete anatomical restoration may not always be possible. When only partial repair is performed, the smaller attachment area on the humerus increases the risk of re-tears and may result in incomplete functional recovery. In such cases, augmentation with artificial tendon enables anatomical restoration to the original shape. Artificial tendon augmentation is technically complex and challenging, so it's not offered at many hospitals. The fundamental principle of all surgery is anatomical restoration of damaged tissue. Even when this isn't fully achievable, getting as close to anatomical restoration as possible is crucial for optimal outcomes. The patient is now functioning almost normally and is very satisfied with her results. Even anatomically irreparable massive rotator cuff tears can recover to normal!!!
