Massive rotator cuff tear repair using Human Dermal Allograft (Graftjacket): Short Term Results with MRI Correlation

Background: Surgical repair of extensive rotator cuff tears can lead to pain relief and improved function, however, the structural failure rates are unacceptably high (50-95%) despite recent surgical advances. A bridging reconstruction of the rotator cuff can be done when a primary repair is not possible due to tear size, chronicity, retraction, or significant tension. Recently, various biologic and synthetic grafts to bridge the remaining defect in a rotator cuff repair has been incorporated in an effort to improve the outcomes of rotator cuff repairs.

Purpose: to retrospectively analyze prospectively collected data of the clinical and radiological results of patients with extensive rotator cuff tears that required arthroscopic reconstruction using human dermal allograft (graftjacket) bridging at a minimum of 6 months follow up.

Materials and methods: 56 patients underwent arthroscopic repair of extensive rotator cuff tear with graftjacket bridging. Preoperative and postoperative evaluation included general assessment by the Western Ontario Rotator Cuff (WORC) questionnaire, preoperative and postoperative radiographs and MRI scans.

Results: Fifty-six patients met inclusion criteria. Forty-one patients (70.7%) were males. The mean age of the study population was 58.60 years. Mean follow-up period of 20.17 months,

The mean preoperative and postoperative WORC score were 36.9 and 80.5 (p<0.0001). Improvement in WORC score was also significant when analyzed by gender (males p=0.017, females p=0.005).

Mean radiographic follow up was 19 months. Five patients demonstrated full thickness tear in the graft-tendon junction. Mean thickness of the graft as measured on coronal plane was 2.6mm (range 2-5mm), 2.3mm (range 2-3mm), 3.8 (range 2-6mm) on the medial, middle, lateral aspect of the graft respectively. No noteworthy changes in fatty atrophy or arthritis level were noted.

Conclusions: Arthroscopic repair of large/massive rotator cuff tears using human dermal allograft augmentation or bridging (graftjacket) demonstrates promising result at a minimum of 6 months follow up.