Note: To access the supplementary Table 1 accompanying this report, visit the April issue of Arthroscopy at www.arthroscopyjournal.org.
Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleArthroscopic Replacement of Massive, Irreparable Rotator Cuff Tears Using a GraftJacket Allograft: Technique and Preliminary Results
Section snippets
Methods
From March 2003 to March 2005, the senior author (S.J.S.) performed 16 arthroscopic GraftJacket allograft (AGJA) procedures. GJA is a freeze-dried acellular human dermal matrix that is harvested and prepared to preserve the vascular channels, collagen, elastin, and proteoglycan constituents while eliminating all cellular components. All of the tears were classified as massive rotator cuff tears as defined by DeOrio and Cofield27 (tears that are ≥5 cm or involve 2 tendons [or both]). In 14
Results
At a mean follow-up of 26.7 months (range, 12 to 38 months), 15 of 16 patients were satisfied with their procedure. A summary of the results is included in Table 1 (online only, available at www.arthroscopyjournal.org). According to the modified UCLA shoulder score, there were 4 excellent, 9 good, 3 fair, and 0 poor results (with good or excellent results in 75%). Overall, the mean UCLA score improved from 18.4 preoperatively to 30.4 postoperatively (P = .0001). All components of the UCLA score
Discussion
Irreparable rotator cuff tears are a difficult problem to manage for orthopaedic surgeons. Despite much investigation and clinical debate surrounding this diagnosis, there is not an accepted treatment algorithm. On one hand, many surgeons argue that a thorough decompression and debridement provide a significant reduction in pain and a modest improvement in function.13, 14 Rockwood et al.30 reported satisfactory results in 83% of shoulders at a mean of 6.5 years of follow-up. Other
Conclusions
Our study supports the hypothesis that GJA is a viable treatment option for surgical salvage in select cases of symptomatic massive, irreparable rotator cuff pathology. This treatment option may provide patients with decreased pain and increased function despite a previously irreparable rotator cuff tear.
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S.J.S. is a paid consultant for Conmed/Linvatec, Largo, Florida, and Wright Medical Technology, Arlington, Tennessee. The other authors report no conflict of interest.