Healing and Functional Results of Dermal Allograft Augmentation of Complex and Revision Rotator Cuff Repairs

Abstract

Background: Primary rotator cuff repairs in complex cases (older patient age, larger tear sizes, chronic tears) and revision repairs are at high risk for failure of healing. Purpose: To examine clinical outcomes and healing rates in complex and revision rotator cuff repairs with dermal allograft augmentation. Study Design: Case series; Level of evidence, 4. Methods: A retrospective study was made of cases performed by 3 fellowship-trained surgeons via a uniform technique involving rotator cuff repairs with allograft augmentation. In all cases, a 1.5-mm, human, decellularized dermal graft was tied on top of the tendon at the medial row and compressed to the rotator cuff footprint using a double-row technique. Postoperative magnetic resonance imaging (MRI) was performed at a minimum of 6 months and American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and 12-Item Short Form Health Survey scores were collected at a minimum of 2 years postoperatively. Results: A total of 35 patients (23 revision repairs, 12 primary complex repairs) were included. The mean patient age was 57.9 years (range, 41.0-70.5 years). All shoulders had 2-tendon tears (supraspinatus and infraspinatus), and 8 included the upper 50% of the subscapularis. At a minimum of 2 years after surgery (mean, 3.2 years), mean ASES and SANE scores improved from 42.4 and 35.3 to 77.6 and 73.5, respectively ( P < .001). In the 23 patients (66%) with postoperative MRI evaluation, 11 (48%) had images showing the tendons were retorn. ASES (89.7 vs 66.4; P = .04) and SANE (84.1 vs 50.5; P = .02) scores were higher in healed patients than those with retears. The retear group had a higher degree of preoperative fatty atrophy of the infraspinatus ( P = .024). Conclusion: Double-row arthroscopic repair with dermal allograft augmentation of complex and revision rotator cuff tears led to improved functional outcomes. Approximately half of patients experienced a failure of healing, which was associated with poorer functional results.

Augmentation of Arthroscopic Rotator Cuff Repair With Cannulated Dermal Allograft Implant

“… 7 In a study involving both revision and primary repair of rotator cuff tears, augmentation with a dermal allograft led to improved outcomes. 19 However, high degree of preoperative fatty atrophy on MRI was associated with poorer functional results, which shows evidence that although augmentation can help healing, it cannot rectify significant atrophy of host muscle. 19 …”

“… 19 However, high degree of preoperative fatty atrophy on MRI was associated with poorer functional results, which shows evidence that although augmentation can help healing, it cannot rectify significant atrophy of host muscle. 19 …”

Rotator Cuff Repair With a Novel Interpositional Allograft Augmentation

“…The allograft is comprised of a highly porous bony matrix with a layer of mineralized cancellous bone that promotes osteointegration with the underlying bone at the repair site. 3,8,9 In this case presentation, a 77-year-old right handdominant man presented with persistent right shoulder pain 3 months following a mechanical, ground-level fall. The patient endorsed mild pain and partially relieved with over-the-counter pain medications; however, he rated his shoulder function as 20% of normal.…”

“…The allograft is comprised of a highly porous bony matrix with a layer of mineralized cancellous bone that promotes osteointegration with the underlying bone at the repair site. 3,8,9…”

Unsuccessful Osteochondral Allograft Cap to Prevent Overgrowth in a Pediatric Patient with Previous Transtibial Amputation

“…8). Although limited literature exists on the use of dermal allografts to increase residual limb padding, they have been used during rotator cuff repairs to promote postoperative healing and enhance structural integrity with high rates of success and low rates of complication 11,12 . Finally, we closed the wound in layers and placed the patient in a well-padded bolster dressing.…”