Bridging Reconstruction With Interpositional Dermal Allograft Has Superior Healing Than Does Maximal Repair for Treatment of Large to Massive, Irreparable Rotator Cuff Tears—Secondary Analysis of a Randomized Control Trial

Abstract

PurposeThe purpose of this study was to compare the radiographic results of bridging rotator cuff reconstruction (BRR) with dermal allograft and maximal repair for large or massive, irreparable rotator cuff tears. MethodsThis was a secondary analysis of data from a single-center, blinded-observer, randomized controlled trial that examined clinical outcomes of BRR compared to maximal repair. A sample size of 30 patients with MRI-proven large or massive (>3 cm), retracted rotator cuff tears and/or involvement of 2 or more tendons were randomly allocated to 1 of 2 groups: maximal repair or BRR using dermal allograft. MRIs were obtained preoperatively and 1 year postoperatively. The primary outcome of this study was the retear rate on MRI. Secondary outcomes included progression of muscle atrophy and fatty infiltration. ResultsThere was no difference in age or preoperative tear size between the two groups. Patients treated with BRR had decreased retear rate (21%) compared with patients who received maximal repair alone (87%). There was no difference in the number of patients who had progression of muscle atrophy (p=0.088 for supraspinatus and p=0.738 for infraspinatus) or fatty infiltration (p=0.879 for supraspinatus and p=0.693 for infraspinatus) between the two groups. A significant increase in mean postoperative supraspinatus muscle atrophy was identified in the maximal repair group (p=0.034). ConclusionThe results of this secondary analysis of a randomized controlled trial comparing radiographic results of maximal repair vs BRR using dermal allograft in the treatment of large or massive rotator cuff tears show that BRR results in a significantly reduced structural failure rate and a trend towards better preservation of supraspinatus muscle mass compared to maximal repair.