Summary

Arthroscopic cuff repair using a donated human allograft dermis has the potential to maintains the graft’s natural biomechanical and biochemical properties is an excellent, though technically demanding option for the augmentation of "irreparable" supraspinatus tendon tears with 100% graft integrity at the 24 weeks follow-up and significantly improved functional scores at 1 year of follow up.

Abstract

Introduction

Massive rotator cuff tears presents a challenge for the shoulder surgeon. Over the years many surgical techniques were introduced to overcome the difficulties in order to achieve solid repair. None proved to provide long-term reliable outcomes.

The use of scaffolds to augment cuff repair is gradually gaining popularity, and it is nowadays, the preferred methods used by many shoulder surgeons worldwide. Allopatch HD® is a donated human allograft dermis, minimally processed, which has the potential to maintain the graft’s natural biomechanical and biochemical properties.

The purpose of this study was to evaluate the functional outcome and retear rate of an arthroscopic Allopatch augmentation for irreparable supraspinatus tendon tears. The time point for examination of cuff integrity was six months, chosen on the basis of in vivo animal studies of rotator cuff repair healing process.

Materials And Methods

Patients who underwent arthroscopic rotator cuff repair with Allopatch allograft augmentation for the treatment of massive rotator cuff, between January 2019 and July 2021, by a single surgeon
were included in the study.

The unique surgical technique was developed and well documented by the surgeon. It allows maximum contact of the Allopatch to the bone in a double row configuration. It further ensures optimal graft fixation, with medial, anterior, and posterior attachments.
The assessment included ultrasound and clinical review at 6 weeks, 12 weeks, 24 weeks. Cuff and Allopatch integrity on ultrasound were classified as intact, segmental, or complete retear.

Preoperative patient-reported outcome measures (PROMs) were analyzed including Western Ontario Rotator Cuff Index (WORC) and Oxford Shoulder Score (OSS) and at 12 months following surgery were recorded.

Results

Overall, 26 patients were included in the study, 22 primary and 4 revision cuff repair surgeries. This group of patients consisted of 21 males and 5 females with an average age at surgery of 57.5 years (range 43-71). The average graft thickness used for the augmentation was 2.8 mm (range 1.8-4.2).
All patients underwent a check ultrasound at 24 weeks following surgery and all, 100%, demonstrated intact Allopatch repair.

On average, patients demonstrated improvement in all the functional scores from the preoperative period to the 12 months post-operative follow-up. OSS significantly increased from 27.07 to 43.2 and WORC significantly increased from 28.38% to 76.02% percentage of normal. One patient who suffered from significant post-operative pain and stiffness underwent re-operation, arthroscopic release of adhesions, 8 months following the repair with significant improvement.

Conclusions

Arthroscopic cuff repair using a dermal Allopatch, is an excellent, though technically
demanding option, for the Augmentation of irreparable Supraspinatus tendon tears with 100% graft integrity at the 24 weeks follow-up in our case series and significantly improved functional scores at 1 year of follow-up.