Arthroscopic revision rotator cuff repair of large and massive retears using an interpositional bridging dermal allograft

Abstract

Background: The purpose of this study was to report the clinical outcomes and retear rate following arthroscopic interpositional bridging dermal allograft for revision rotator cuff repair of large and massive retears. Methods: Twenty-three patients were retrospectively reviewed at a minimum follow-up of 24 (mean, 47; range, 24-77) months after revision rotator cuff repair using an interpositional bridging dermal allograft. There were 17 males and 6 females with a mean age of 56 (range, 40-74) years. Clinical outcomes were assessed using range of motion, the American Shoulder and Elbow Surgeons score and Western Ontario Rotator Cuff Index. Graft integrity was assessed at 12-months using magnetic resonance imaging. Results: The interval between the primary rotator cuff repair and interpositional bridging graft was a mean of 82 (range, 7-192) months. Forward flexion improved from a mean of 145° (range, 60-180°) preoperatively to 152° (range, 135-170°) postoperatively (P = .3561). There was a decrease in external rotation from a mean of 50° (range, 20-80°) preoperatively to 37° (range, 0-45°) postoperatively (P = .0021). The American Shoulder and Elbow Surgeons score improved (P = .0196) from a mean of 50 (range, 10-88) to 69 (range, 22-97), and the Western Ontario Rotator Cuff index improved (P = .0008) from a mean of 34 (range, 3-90) to 57 (range, 14-93). The graft was intact in 39% of patients. No patients underwent further surgery. Conclusion: Interpositional bridging grafting for revision rotator cuff repair of large and massive retears leads to a significant improvement in functional outcome but is associated with a high retear rate.

Keywords

• Allograft
• Bridging grafting
• Revision surgery
• Rotator cuff repair
• Rotator cuff retear
• Rotator cuff tear