Large to Massive Rotator Cuff Tears With Only Partial Repair Possible Treated With Human Dermal Allograft Results in...

To compare the clinical and radiologic outcomes of incomplete rotator cuff repair with and without human dermal allograft patch in patients with large to massive rotator cuff tears.

A retrospective analysis was performed on patients who underwent arthroscopic rotator cuff repair with footprint medialization between March 2013 and September 2022, with a minimum 2-year follow-up for clinical outcomes. Patients were included if they had a full-thickness rotator cuff tear measuring ≥3.0 cm and underwent incomplete repair due to excessive tension after medialization. Propensity score matching (1-to-1) was performed between the patch augmentation and incomplete repair-only groups by preoperative variables, including tear size, chronicity, and tendon quality. Clinical outcomes were assessed via visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and Single Assessment Numeric Evaluation score, along with active range of motion. Structural integrity was evaluated using magnetic resonance imaging at 6 months, ultrasonography at 1 year, and at final follow-up.

Among 1129 patients, 174 met the inclusion criteria: 43 received human dermal allograft patch augmentation, and 131 underwent incomplete repair. Propensity score matching produced 36 matched pairs for analysis. At final follow-up, the patch augmentation group had significantly better outcomes, including lower visual analog scale for pain score (0.6 ± 0.9 vs 1.2 ± 1.3, P = .035), and higher American Shoulder and Elbow Surgeons (93.3 ± 4.5 vs 89.0 ± 6.6, P = .002), Constant (89.8 ± 4.9 vs 86.6 ± 7.3, P = .031), and Single Assessment Numeric Evaluation scores (90.6 ± 6.8 vs 84.7 ± 8.4, P = .002). Furthermore, 83.3% of the patch group and 77.8% of the control group achieved the minimal clinically important difference of 9.1 for the American Shoulder and Elbow Surgeons score. Both groups showed significant range of motion improvement with no intergroup difference. Magnetic resonance imaging at 6 months showed healing failure in 8.3% of the patch augmentation group versus 27.8% in the incomplete repair group (P = .063). At the final follow-up, retear rates reached 33.3% in the incomplete repair group but remained at 8.3% with patch augmentation (P = .009).

Human dermal allograft patch augmentation in patients with large to massive rotator cuff tears led to lower retear rates and superior clinical outcomes compared with incomplete repair alone.

Level III, retrospective comparative case-control study.