Editorial Commentary: Reflections From a Mature Arthroscopic Shoulder Surgeon on the History and Current Benefits of Augmentation for the Revision of a Massive Rotator Cuff Tear Using Acellular Human Dermal Matrix Allograft

Abstract

Acellular human dermal matrix allografts are now being used to augment and sometimes replace severely damaged rotator cuff tissue. I have been interested in this important aspect of orthopaedics for 15 years and am pleased to have the opportunity to share my personal reflections of some of the highlights in science and the literature that helped get to the point now where we can expect greater than 80% healing even in these difficult cases of revision after massive failed cuff repair. The field of tissue engineering will certainly be a critical part of our rotator cuff surgical future.

Revision of a Failed Latissimus Dorsi Transfer for a Massive Rotator Cuff Tear With Arthroscopic Anatomic Bridging Reconstruction Using an Acellular Human Dermal Matrix Allograft

“…The AABR technique for MRCT using various biologic and synthetic grafts has emerged as an attractive and promising option in the past decade with good short-term to medium-term results (Tables 1 and 2). 5, 6, 8, 15 In particular, AABR using AHDMA has produced good results and improved function on objective testing 1, 5, 7, 8, 9, 15. Lewington et al 8 .…”

“…This foremost advantage of this anatomic reconstruction technique is that it has the potential for biological regeneration of “cuff-like” tissue, thereby arresting superior migration of the humeral head and cuff arthropathy 5, 15, 16. It does not burn any bridges for the patient and the surgeon because in the event of an eventual failure, other options for management are still open.…”

“…Bridging, or anatomic reconstruction of the rotator cuff with acellular human dermal matrix allograft (AHDMA), is increasingly being used as a viable, ‘biological’ solution for massive, irreparable cuff tears with good short-term to medium-term results being reported by different surgical groups across the world 1, 5, 6, 7, 8, 9, 10…”

The “Pull-Over” Technique for All Arthroscopic Rotator Cuff Repair With Extracellular Matrix Augmentation

“…These include use of patch augmentation and administration of platelet-rich plasma and bone marrow aspirate concentration to the repaired construct. 2 Augmentation of the repair with the extracellular matrix or synthetic patch has regained popularity in recent years as a result of improved arthroscopic instrumentation and techniques as well as advances in processing techniques that significantly enhance removal of antigenic material form the extracellular matrix, therefore minimizing risks of immune and inflammatory response and adhesions. 5 There has also been a number of biomechanical, histological, clinical, and radiological reports that have suggested enhanced construct strength as well as good function and healing with the use of augmentation with rotator cuff tears.…”

“…One of the strategies is augmentation of the repair with a patch. 2 Arthroscopic augmentation is, however, technically demanding with challenges in introduction and stabilization of the patch. The troublesome steps that are critical include maneuvering of the patch in the intended orientation to the correct location without it bunching and folding up or suture limbs becoming tangled and intertwisted, and the robust securing of the augment.…”