Arthroscopically implanting freeze-dried acellular human dermal matrix allograft may offer a viable option for the surgical salvage of patients with irreparable massive rotator cuff tears.
James L. Bond, MD (pictured), and colleagues at several U.S. centers investigated whether a GraftJacket allograft (Wright Medical Technology) could be used as a biologic scaffold to span a rotator cuff deficiency.
"This treatment option may provide patients with decreased pain and increased function, despite a previously irreparable rotator cuff tear," the authors wrote in the study.
The GraftJacket allograft is a freeze-dried acellular human dermal matrix that is prepared in manner which preserves the vascular channels, collagen, elastin, and proteoglycan constituents, while eliminating cellular components, according to the study.
Bond and colleagues evaluated outcomes for 16 patients with massive rotator cuff tears that measured at least 5 cm and/or involved two tendons. The patients averaged 54.4 years of age, cuff tears averaged 4.25 cm by 4.95 cm, and the allografts averaged 1.02 mm.
Of the 16 cases, repairs had previously been attempted at other centers in 14 cases; the remaining two had acute tears that had occurred within 3 months of treatment, according to the study.
All patients initially underwent arthroscopic debridement. "An [arthroscopic GraftJacket allograft] augmentation was not routinely scheduled after the initial debridement. To date, however, all of the patients ... have returned to the clinic requesting a second-stage [arthroscopic GraftJacket allograft], at a mean of 6 weeks after the initial debridement," the authors noted.
"Regarding the SST (Simple Shoulder Test) evaluation, the percentage of patients able to perform each task consistently increased at the 3-month, 6-month, and 1-year follow-up visits in all categories except the ability to carry 20 lb comfortably on the side of the rotator cuff deficiency," they reported. "Interestingly, all of the patients who had an intact [arthroscopic GraftJacket allograft] at 2-year follow-up were able to perform this task without pain."
No patients experienced either intra- or postoperative complications, and none have developed infections or allograft rejection, they noted.
At latest follow-up, three patients showed clinical and radiographic evidence of graft failure, but none required graft removal. "In fact, all three patients were satisfied at their last clinical follow-up because their preoperative pain was significantly relieved," the authors added.
Illustration: Bone & Joint Hospital, Oklahoma City, OK.
American Academy of Orthopaedic Surgeons (04/08)
Abstract (Arthroscopy, Volume 24, Issue 4, Pages 403.e1-403.e8 (April 2008))