Allograft reconstruction of rotator cuff had better outcomes, lower retear rate vs repair
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Reconstruction of massive rotator cuff tears with an acellular dermal matrix allograft yielded better patient-reported outcomes and a lower retear rate compared with rotator cuff repair, according to results.
Ivan H. Wong, MD, FRCSC, MAcM, and colleagues randomly assigned 29 patients with massive rotator cuff tears to undergo either rotator cuff reconstruction with an acellular dermal matrix allograft or maximal rotator cuff repair. Researchers collected Western Ontario Rotator Cuff (WORC) index scores at 2 years as the primary outcome. Secondary outcomes included the DASH score, retear rate, progression to rotator cuff arthropathy and acromial humeral distance.
Wong noted the repair and reconstruction groups had significant differences in the change in WORC scores.
“The repair group had an improvement of 12 points on the WORC score, whereas the reconstruction group had an improvement of 41 points on the WORC score,” Wong said at the Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Specialty Day.
He added 86% of patients in the reconstruction group met the minimal clinically important difference for the WORC index vs. 40% in the repair group. MRI evaluation showed a retear rate of 21% and 87% in the reconstruction and repair group, respectively, according to Wong.
“So, the repair group had significantly more complete retears than the reconstruction group,” Wong said.
Wong noted two patients in the reconstruction group required revision surgery, one of which was due to graft tear, while five patients in the repair group underwent revision surgery.
“The acromial humeral distance improved with the reconstruction group, but got significantly worse in the repair group,” Wong said. “In fact, [in] the maximal repair group, 20% of these progressed to end-stage glenohumeral arthritis, which there was no arthroscopic salvage for this type of failure.”
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Wong IH, et al. Paper 5. Presented at: Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Specialty Day; March 17 and 18, 2021 (virtual meeting).
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