My indication for augmented cuff repair is that there is a massive cuff repair, but it must be repairable, I often use a Pitch-Patch when I look at a pre-op MRI scans, where the tendon looks very tendinopathic, there is increased signal in the T2 sequences and intraoperatively I feel that there were tendons that were delaminated, degenerated, and the mechanical strength is not very good when I try putting a traction suture on, therefore in those situations, I would prefer to put an augmented repair on. Often, I pre-warn the patients based on pre-operative MRI scans, based on whether I see a retractive tear and tendinopathic changes on T2 images.

I feel the strength of the Pitch-Patch is such that it is readily available on the shelf, it can be used at any time. It gives you immediate mechanical strength as soon as it is implanted, and the fact that it allows tissue ingrowth and ongrowth, it is simply a scaffold to create new tissues, so I think there is a lot of benefit when using something which allows you to increase the strength of the tendon

I think the Pitch-Patch doesn’t cause any, in my experience of using this for 6-7 years now, adverse foreign body reactions to the Pitch-Patch. In one of the patients that had a cuff repair many years ago, ended up having a shoulder replacement due to arthritic changes, when we went in there, the cuff looks really good, we cannot see the PP at all, if it wasn’t for the little bit of suture used, we wouldn’t be able to tell the Pitch-Patch has been there as it was simply covered with new fibrous tissue.

I think the benefit is such that it first gives confidence in the repair of the tendon and enhances the acceleration of the rehabilitation process. Often at the end of the operation, I will take the arm through a passive range of motions, and I can see that the cuff repair is very stable, hence I have confidence that mobilising them early on week 3. Typically, I start an active assisted range of motions below the shoulder height at week 3 because of the use of the patch.

I’ve used nearly 20 Pitch-Patch, but for different indications. So, some of them I used for arthroscopic repair, which is the majority of the cases. But some of them I use for trauma situations. For example, if someone has a proximal humerus fracture and there is cuff damage there, I will repair the cuff, and sometimes I will put a Pitch-Patch on.

In my experience in using all of these, I have not had one come back, fail, or need a revision to remove the cuff, but this is only based on a short period of practice.

I would say that if any new surgeons felt they were sceptical or worried about using this, then don’t be afraid of doing a mini-open when you complete the lateral row fixation of your patch. See the results that have been published by Dr Jan Leuzinger before, and it was amazing results from him. So I think clinically it has good results, and technically, there are ways to make it easier to use, and it does work.