Summary

In large to massive rotator cuff tears, arthroscopic partial repair with allogenous dermal scaffold augmentation yielded superior tendon thickness and increased acromio-humeral distance postoperatively compared to partial repair only

Abstract

Background

Treatment of large to massive rotator cuff tears is challenging and has led to use of scaffold augmentation for better healing. Although poor tendon quality and vascularity are known for failure of rotator cuff healing, biological and mechanical repair with allogenous augmentation has shown a promising outcome as a viable treatment option
Objectives: We hypothesized that incorporation of allogenous dermal scaffold augmentation in addition to large to massive rotator cuff repair would result in improved clinical outcomes and mechanical strength supported by radiologic evidence of superior tendon integrity and less postoperative retears.
Study Design & Methods: The study was composed of a total of 55 patients with large to massive rotator cuff tears. The patients were divided into two groups; Group A (28 patients) underwent arthroscopic partial repair, and Group B (27 patients) had allogenous dermal scaffold graft augmentation after partial repair. Clinical assessment included University of California-Los Angeles, Constant-Murley score, and visual analogue scale at preoperative, postoperative 3rd, 6th, and 12th month periods. Radiologic assessment, including magnetic resonance imaging, was performed preoperatively and postoperatively to assess repaired tendon integrity, based on Sugaya classification.

Results

The mean follow-up period for Group A and B were 14.5 months and 16.3 months, respectively. In both groups, all clinical functional scores improved at the final follow-up. Postoperative magnetic resonance imaging revealed 4 retears and 2 retears in group A and B, respectively, and superior postoperative repaired tendon thickness in Group B to Group A with statistical significance (p-value 0.00). In addition, acromio-humeral distance was significantly improved postoperatively in both groups, from 7.25 mm to 9.44 mm in Group A and from 7.41 mm to 10.99 mm in Group B, but the group B showed superior improvement in acromio-humeral distance than group A. (p-value 0.05)

Conclusions

In large to massive rotator cuff tears, arthroscopic partial repair with allogenous dermal scaffold augmentation yielded superior tendon thickness and increased acromio-humeral distance postoperatively compared to partial repair only.