Clin Orthop Surg.  2019 Jun;11(2):200-207. 10.4055/cios.2019.11.2.200.

Failure of Dermal Allograft Repair of Massive Rotator Cuff Tears in Magnetic Resonance Imaging and Clinical Assessment

• Gouk CJ
• Shulman RM
• Buchan C
• Thomas MJ
• Taylor FJ

• KMID: 2445056
• DOI: http://doi.org/10.4055/cios.2019.11.2.200

Abstract

BACKGROUND
Massive retracted rotator cuff tears represent a therapeutic dilemma, particularly in the young and middle-aged patients who are not appropriate for a reverse total shoulder replacement. Interposition grafting using human dermal allograft offers an alternative treatment.
METHODS
A retrospective review of all patients who underwent interposition grafting using human dermal allograft between December 2013 and May 2015 for massive rotator cuff tears at our tertiary referral center was performed. Preoperative and 6 month postoperative magnetic resonance imaging (MRI) assessments were performed in all patients, with postoperative graft integrity being the primary outcome measure. Clinical evaluation was performed using the Oxford shoulder score, Constant score, and Disabilities of the Arm, Shoulder and Hand (DASH) score.
RESULTS
The mean age at the time of follow-up was 54 years. On MRI, 84% of grafts were seen to have failed at 6 months. Strength was grossly reduced on the operative side when supraspinatus and subscapularis were tested; despite this, Constant score (mean, 48.2) was comparable to that in the previous reports. DASH and Oxford scores were a mean of 24.94 and 37.16, respectively.
CONCLUSIONS
Based on these results, in particular the MRI findings, we cannot advocate the use of dermal allograft as an interposition graft for the repair of massive rotator cuff tears.

Keyword

Rotator cuff injuries; Acellular dermal graft tissue; Shoulder; Operative surgical procedure; Magnetic resonance imaging

Figure

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  Fig. 1 Proton density fat-saturated sagittal magnetic resonance image demonstrates the typical uniform thin low signal appearance of an intact GraftJacket (arrowhead) traversing the massive rotator cuff tear.

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  Fig. 2 An axial diagrammatic representation of the most common site of GraftJacket (GJ) failure. The coracoid process (C), subscapularis (SSc), supraspinatus (SS), and infraspinatus (IS) are labelled for orientation.

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  Fig. 3 Proton density fat-saturated axial magnetic resonance image demonstrates the typical anterior displacement of the dehiscent posterolateral GraftJacket margin (arrowheads) uncovering the humeral head (H). The coracoid process (C) and supraspinatus (SS) are labelled for orientation.

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  Fig. 4 Proton density fat-saturated sagittal magnetic resonance image demonstrates the GraftJacket (arrowhead) with the posterior deficit (arrow) commonly encountered with failure or dehiscence.

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