Biologic allograft material may serve as a scaffold for repairing massive rotator cuff tears

Arthroscopically implanting freeze-dried acellular human dermal matrix allograft may offer a viable option for the surgical salvage of patients with irreparable massive rotator cuff tears, a retrospective study suggests.

"This treatment option may provide patients with decreased pain and increased function, despite a previously irreparable rotator cuff tear," the authors wrote in the study.

James L. Bond, MD, and colleagues at several U.S. centers investigated whether a GraftJacket allograft (Wright Medical Technology) could be used as a biologic scaffold to span a rotator cuff deficiency. They published their results in Arthroscopy.

The GraftJacket allograft is a freeze-dried acellular human dermal matrix that is prepared in manner which preserves the vascular channels, collagen, elastin and proteoglycan constituents, while eliminating cellular components, according to the study.

Bond and colleagues evaluated outcomes for 16 patients with massive rotator cuff tears that measured at least 5 cm and/or involved two tendons. The patients averaged 54.4 years of age, cuff tears averaged 4.25 cm by 4.95 cm, and the allografts averaged 1.02 mm.

Of the 16 cases, repairs had previously been attempted at other centers in 14 cases; the remaining two had acute tears that had occurred within 3 months of treatment, according to the study.

All patients initially underwent arthroscopic debridement. "An [arthroscopic GraftJacket allograft] augmentation was not routinely scheduled after the initial debridement. To date, however, all of the patients ... have returned to the clinic requesting a second-stage [arthroscopic GraftJacket allograft], at a mean of 6 weeks after the initial debridement," the authors noted.

At 26.7 months mean follow-up, investigators found that 15 of the 16 patients were satisfied with their outcomes.

Overall, the modified UCLA shoulder score significantly improved, from a mean score of 18.4 points preoperatively to 30.4 points postoperatively. Based on individual UCLA scores, results were excellent in four cases, good in nine and fair in three, according to the study.

Also, all components of the UCLA score showed functional improvements, the authors noted.

Pain scores improved from an average of 4.6 points preoperatively to 9.8 points at follow-up. Flexion increased from an average of 106° to 142°, and range of motion in external rotation improved from an average of 43° preoperatively to 47.2° at follow-up.

Constant scores also significantly improved, from 53.8 points to 84 points, the authors reported.

"Regarding the SST (Simple Shoulder Test) evaluation, the percentage of patients able to perform each task consistently increased at the 3-month, 6-month and 1-year follow-up visits in all categories except the ability to carry 20 lb comfortably on the side of the rotator cuff deficiency," they reported. "Interestingly, all of the patients who had an intact [arthroscopic GraftJacket allograft] at 2-year follow-up were able to perform this task without pain."

No patients experienced either intra- or postoperative complications, and none have developed infections or allograft rejection, they noted.

At latest follow-up, three patients showed clinical and radiographic evidence of graft failure, but none required graft removal. "In fact, all three patients were satisfied at their last clinical follow-up because their preoperative pain was significantly relieved," the authors added.

For more information:
Bond JL, Dopirak RM, Higgins J, et al. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: Technique and preliminary results. Arthroscopy. 2008;24:403-409.