Rotator Cuff Repair with Autologous Fascia Lata Augmentation in Patients at High Risk for Repair Failure: Five-Year Follow-Up Outcomes

Background: Large-to-massive rotator cuff tears with advanced fatty degeneration and retears after previous repair remain major clinical challenges. Despite advances in surgical techniques, clinical outcomes remain unsatisfactory. This study evaluated the 5-year outcomes of rotator cuff repair (RCR) with autologous fascia lata augmentation in patients at high risk of repair failure. Methods: We retrospectively reviewed 14 patients (mean age, 64.1 ± 6.6 years) who underwent RCR with autologous fascia lata augmentation. All patients had large-to-massive rotator cuff tears with Goutallier grade 3 or 4 fatty degeneration or retears after prior cuff repair. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, and the Constant score. Postoperative cuff integrity was assessed using magnetic resonance imaging (MRI) or ultrasonography. Results: At the 1-year follow-up, significant improvements were observed in pain VAS (from 5.1 ± 1.6 to 1.3 ± 1.0, p < 0.001), ASES score (from 51.9 ± 19.1 to 85.2 ± 7.8, p < 0.001) and Constant score (from 51.3 ± 13.8 to 70.8 ± 7.0, p < 0.001). These improvements were maintained throughout the 5-year follow-up. Postoperative imaging demonstrated an overall retear rate of 7.1% (1/14). No patient underwent revision surgery during follow-up. Conclusions: Autologous fascia lata augmentation was associated with sustained pain relief and functional improvement throughout the 5-year follow-up, with a low retear rate on postoperative imaging. These findings suggest that autologous fascia lata may be a viable graft option for rotator cuff augmentation in selected patients, although further prospective comparative studies with larger cohorts are warranted.