Original Article
Arthroscopic Replacement of Massive, Irreparable Rotator Cuff Tears Using a GraftJacket Allograft: Technique and Preliminary Results

https://doi.org/10.1016/j.arthro.2007.07.033Get rights and content

Purpose: Our purpose was to assess the short-term results and describe the technique of arthroscopic repair of irreparable rotator cuff tears by use of a GraftJacket allograft (Wright Medical Technology, Arlington, TN). Methods: Between March 2003 and February 2004, 16 patients with massive, contracted, immobile rotator cuff tears were treated with arthroscopic placement of a GraftJacket allograft by a single surgeon. Patients were followed up for 1 to 2 years. All were evaluated preoperatively and postoperatively by use of the modified University of California, Los Angeles scoring system, Constant score, and Simple Shoulder Test. Magnetic resonance imaging was performed postoperatively at 3 months and 1 year. Results: At a mean follow-up of 26.8 months (range, 12 to 38 months), 15 of 16 patients were satisfied with the procedure. The mean University of California, Los Angeles score increased from 18.4 preoperatively to 30.4 postoperatively (P = .0001). The Constant score increased from 53.8 to 84.0 (P = .0001). Statistically significant improvements were seen in pain, forward flexion, and external rotation strength. Thirteen patients had full incorporation of the graft into the native tissue as documented on magnetic resonance imaging. There were no complications in this cohort of patients. Conclusions: Our study supports GraftJacket allograft as a viable solution for surgical salvage in select cases of massive, irreparable rotator cuff pathology. This treatment option may provide patients with decreased pain and increased function despite a previously irreparable rotator cuff tear. Level of Evidence: Level IV, therapeutic case series.

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.

References (33)

  • R.M. Seldes et al.

    Arthroscopic insertion of a biologic rotator cuff tissue augmentation after rotator cuff repair

    Arthroscopy

    (2006)
  • S.S. Burkhart

    Partial repair of massive rotator cuff tears: The evolution of a concept

    Orthop Clin North Am

    (1997)
  • G.M. Gartsman et al.

    Arthroscopic repair of full-thickness tears of the rotator cuff

    J Bone Joint Surg Am

    (1998)
  • J.J. Warner

    Management of massive irreparable rotator cuff tears: The role of tendon transfer

    Instr Course Lect

    (2001)
  • S.S. Burkhart et al.

    Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: Technique and preliminary results

    Arthroscopy

    (2004)
  • S.S. Burkhart et al.

    Margin convergence of the posterior rotator cuff to the biceps tendon

    Arthroscopy

    (2004)
  • Cited by (0)

    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.

    Note: To access the supplementary Table 1 accompanying this report, visit the April issue of Arthroscopy at www.arthroscopyjournal.org.

    View full text