Clinical outcomes following bursal acromial reconstruction using a dermal acellular graft for irreparable rotator...

Irreparable rotator cuff tears remain a challenge for orthopedic surgeons. Reverse shoulder arthroplasty (rTSA) has become an increasingly common option for these patients. However, in patients lacking arthritis and with a functionally balanced shoulder, alternative and less invasive surgical options have been pursued. In this study, we seek to investigate the outcome of arthroscopically placing an allograft on the undersurface of the acromion for pain relief.

A retrospective review was conducted of all patients who underwent a bursal acromial reconstruction using a dermal acellular graft by a single surgeon. To qualify for inclusion, patients were required to have what was deemed an irreparable rotator cuff tear, absence of advanced osteoarthritis, a functionally balanced shoulder preoperatively as evidenced with intact forward elevation of at least 120°, and a minimum of 2-year follow-up. Clinical outcomes were measured preoperatively, 3 months postoperatively, and at final 2-year follow-up using visual analog scale for pain (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and Single Assessment Numeric Evaluation (SANE) score. One-way analysis of variance was used to determine significant difference between preoperative and final follow-up. An additional satisfaction survey was completed at final follow-up.

Twenty-two patients were included in the study. Three patients were converted to rTSA during the follow-up period because of limited active range of motion. The remaining patients had a significant improvement in VAS, ASES, and SANE scores (P < .001). The average improvement in VAS, ASES, and SANE score at final follow-up was 4.9, 46, and 49, respectively. The average satisfaction score at final follow-up was 8.7 (95% confidence interval, 7.9-9.5) on a scale from 1 to 10. There were no major or minor complications.

Bursal acromial reconstruction using a dermal acellular graft in the setting of an irreparable rotator cuff tear, with a functionally balanced shoulder in the absence of osteoarthritis, is effective at improving patient-reported outcomes and producing high patient satisfaction. However, it was associated with a conversion to rTSA within 2 years in 3 of the 22 patients. This surgical technique presents a potential alternative to rTSA for this subset of patients with an irreparable rotator cuff tear who have failed conservative treatment. Further research is warranted to investigate how these outcomes compare to other procedures in high-level randomized controlled trials and if these outcomes can be sustained with longer follow-up.