Use of Acellular Dermal Matrix for Reconstruction of Massive Rotator Cuff Tears in an Older Population

Background: Management of massive rotator cuff tears in shoulders without glenohumeral arthritis remains problematic for surgeons. Repairs of massive rotator cuff tears have failure rates of 20% to 94% at 1 to 2 years postoperatively as demonstrated with arthrography, ultrasound, and magnetic resonance imaging. Additionally, inconsistent outcomes have been reported with debridement alone of massive rotator cuff tears, and limitations have been seen with other current methods of operative intervention, including arthroplasty and tendon transfers. Hypothesis: The use of interposition porcine acellular dermal matrix xenograft in patients with massive rotator cuff tears will result in improved subjective outcomes, postoperative pain, function, range of motion, and strength. Study Design: Case series; Level of evidence, 4. Methods: Sixty patients (61 shoulders) were prospectively observed for a mean of 50.3 months (range, 24-63 months) after repair of massive rotator cuff tears with porcine acellular dermal matrix xenograft as an interposition graft. Subjective outcome data were obtained with visual analog scale for pain score (0-10, 0 = no pain) and Modified American Shoulder and Elbow Surgeons (MASES) score. Active range of motion in flexion, external rotation, and internal rotation were recorded. Strength in the supraspinatus and infraspinatus muscles was assessed manually on a 10-point scale and by handheld dynamometer. Ultrasound was used to assess the integrity of the repair during latest follow-up. Results: Mean visual analog scale pain score decreased from 4.0 preoperatively to 1.0 postoperatively ( P < .001). Mean active forward flexion improved from 140.7° to 160.4° ( P < .001), external rotation at 0° of abduction from 55.6° to 70.1° ( P = .001), and internal rotation at 90° of abduction from 52.0° to 76.2° ( P < .001). Supraspinatus manual strength increased from 7.7 to 8.8 ( P < .001) and infraspinatus manual strength from 7.7 to 9.3 ( P < .001). Mean dynamometric strength in forward flexion was 77.7 N in nonoperative shoulders (shoulder that did not undergo surgery) and 67.8 N ( P < .001) in operative shoulders (shoulder that underwent rotator cuff repair with interposition porcine dermal matrix xenograft). Mean dynamometric strength in external rotation was 54.5 N in nonoperative shoulders and 50.1 N in operative shoulders ( P = .04). Average postoperative MASES score was 87.8. Musculoskeletal ultrasound showed that 91.8% (56 of 61) of repairs were fully intact; 3.3% (2 of 61), partially intact; and 4.9% (3 of 61), not intact. Conclusion: Patients who underwent repair of massive rotator cuff tears with interposition porcine acellular dermal matrix graft have good subjective function as assessed by the MASES score. Patients have significant improvement in pain, range of motion, and manual muscle strength. Postoperative ultrasound demonstrated that the repair was completely intact in 91.8% of patients, a vast improvement compared with results previously reported for primary repairs of massive rotator cuff tears.

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Ultrasonography Technique in the Evaluation of Massive Rotator Cuff Tears Repaired using a Porcine Acellular Dermal Matrix Xenograft through a Mini-open Approach

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1066 ◽

2016 ◽

Vol 6 (1) ◽

pp. 26-34

Author(s):

Alison P Toth ◽

Blake R Boggess

Keyword(s):

High Resolution ◽

Rotator Cuff ◽

Acellular Dermal Matrix ◽

Rotator Cuff Tears ◽

Open Approach ◽

Dermal Matrix ◽

Massive Rotator Cuff Tears ◽

Porcine Acellular Dermal Matrix ◽

Acellular Dermal ◽

Mini Open

ABSTRACT Purpose Massive rotator cuff tears (RCT) have been notoriously difficult to treat, but recently the novel use of interposition biologic scaffold grafts in repair of massive RCT has had promising results. However, there are no published guidelines regarding postoperative imaging evaluation of massive RCT repaired with xenograft. The purpose of this study was to (1) describe how to use ultrasound to evaluate a porcine acellular dermal matrix xenograft after repair of massive RCT and (2) evaluate healing of a xenograft using high-resolution ultrasound. Materials and methods A total of 37 consecutive patients underwent ultrasound evaluation of a repaired RCT at a mean of 33 months follow-up (23–48). Postoperative ultrasound findings were correlated to preoperative and postoperative functional (visual analog scale, Short-form 12, and Modified American shoulder and elbow score) and clinical outcomes (active range of motion and strength). Results Of the 37 patients, ultrasound showed that 33 (89.2%) of the cuff repairs were fully intact, 3 (8.1%) had partial thickness tears, and 1 (2.7%) had a full thickness tear. In this study, the integrity of the repair based on high-resolution ultrasound correlates with functional and clinical outcomes. Conclusion Ultrasound is an effective method to evaluate xenograft interposition grafts used in rotator cuff repair. Neumann JA, Rickert KD, Toth AP, Boggess BR. Ultrasonography Technique in the Evaluation of Massive Rotator Cuff Tears Repaired using a Porcine Acellular Dermal Matrix Xenograft through a Mini-open Approach. The Duke Orthop J 2016;6(1):26-34.

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Reconstruction of large rotator-cuff tears with acellular dermal matrix grafts in rats

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2008.09.004 ◽

2009 ◽

Vol 18 (2) ◽

pp. 288-295 ◽

Cited By ~ 52

Author(s):

Junji Ide ◽

Kenshi Kikukawa ◽

Jun Hirose ◽

Ken-ichi Iyama ◽

Hidetoshi Sakamoto ◽

...

Keyword(s):

Rotator Cuff ◽

Acellular Dermal Matrix ◽

Rotator Cuff Tears ◽

Dermal Matrix ◽

Acellular Dermal

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Reconstruction of irreparable rotator cuff tears with an acellular dermal matrix in elderly patients without joint arthritis

Shoulder & Elbow ◽

10.1177/1758573220965535 ◽

2020 ◽

pp. 175857322096553

Author(s):

Herbert Gbejuade ◽

Mohammed Shakil Patel ◽

Harvinder Singh ◽

Amit Modi

Keyword(s):

Rotator Cuff ◽

Elderly Patients ◽

Acellular Dermal Matrix ◽

Rotator Cuff Tears ◽

Dermal Matrix ◽

Pain Scores ◽

Shoulder Scores ◽

Joint Arthritis ◽

Acellular Dermal ◽

Preoperative Score

Background Reverse shoulder arthroplasty is the mainstay of treatment for symptomatic irreparable rotator cuff tears in elderly patients without arthritis. However, this treatment incurs significant costs and is a major surgical undertaking. This study explores an alternative that involves the reconstruction of irreparable rotator cuff tears using an acellular dermal matrix in elderly patients without established joint arthritis. Methods We prospectively evaluated the reconstruction of massive irreparable rotator cuff tears in 21 patients aged 68 years and over without radiographic glenohumeral joint osteoarthritis in whom conservative management had failed. A human dermal acellular matrix graft was used as a bridging graft for reconstruction. Pain scores, Oxford Shoulder Scores and ranges of movement were all assessed preoperatively and postoperatively. The mean follow-up period was 5.8 years (range 2.6 to 8.9 years). Results Statistically significant ( p < 0.05) improvements were observed in Oxford Shoulder Scores (mean preoperative score, 21; mean postoperative score, 46), pain scores (mean preoperative score, 6; mean postoperative score, 0) and ranges of movement. Patients also reported a high satisfaction rate with the procedure. Discussion Human tissue matrix allografts could serve as a suitable option for the treatment of elderly patients with massive irreparable rotator cuff tears without arthritis.

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Massive Rotator Cuff Tear Bridging Reconstruction Using Acellular Dermal Matrix: Mid-term Results (219)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00327 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0032

Author(s):

Moayd Awad ◽

Sara Sparavalo ◽

Jie Ma ◽

Ivan Wong

Keyword(s):

Rotator Cuff ◽

Total Shoulder Arthroplasty ◽

Acellular Dermal Matrix ◽

Rotator Cuff Tears ◽

Dermal Matrix ◽

Massive Rotator Cuff Tears ◽

Superior Capsular Reconstruction ◽

Patient Reported ◽

Reverse Total Shoulder

Objectives: Management of massive rotator cuff tears remains a challenge despite development of different surgical techniques. Bridging reconstruction was developed to improve clinical outcomes and to avoid the morbidity associated with tendon transfers and arthroplasty. To date, there have been no studies assessing the mid-term clinical outcome for patients undergoing this procedure. The objective of this study was to evaluate the mid-term clinical outcomes of patients who underwent bridging reconstruction using acellular dermal matrix for large/massive rotator cuff tears (> 3 cm). Methods: A retrospective chart review was conducted for patients who underwent bridging reconstruction between 2010 and 2018 by one surgeon (IW). Patients with a minimum follow-up of two years were included. All patients completed self-reported questionnaires (Western Ontario Rotator Cuff (WORC) Index and the Disabilities of the Shoulder, Arm and Hand (DASH) score) pre-operatively and post-operatively at six months, one year and annually thereafter. Results: One hundred charts were reviewed, and 20 patients were excluded due to lack of pre- or post-operative outcome scores. This cohort of patients consisted of 80 patients mean age of 58.6 ± 9.1 years and an average follow-up of 5.1 ± 1.6 years. The mean pre- and post-operative WORC scores (± SD) were 61.4 ± 20.6 and 28.1 ± 25.5 (p < 0.001), respectively. The mean pre- and post-operative DASH scores were 52.2 ± 19.7 and 23.1 ± 22.4 (p < 0.001), respectively. There was an improvement in WORC and DASH over time with the most significant improvement during the first year post-operatively (Figure 1). Seventy-eight percent of patients met the minimal clinically important difference (MCID) for WORC while 77% of patients met the MCID for DASH. Our results show significant mid-term clinical improvement in WORC and DASH scores that is similar to previously published data that showed significant improvements in other patient-reported outcome scores. We believe these positive outcomes to be a result of better force coupling within the shoulder as compared to other surgical treatments such as maximal repair, superior capsular reconstruction, and reverse total shoulder arthroplasty. Conclusions: Arthroscopic bridging reconstruction for the treatment of massive rotator cuff tears results in significant improvement of patient reported outcomes (as measured using the WORC and DASH scores) at a mean follow up of five years. This may suggest that bridging reconstruction is a good treatment alternative as compared to superior capsular reconstruction or reverse total shoulder arthroplasty. Longer follow-up with a prospective study design is necessary to determine the longevity of these outcomes.

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