INTRODUCTION: Massive cuff tears can prove especially challenging to treat. Although these types of tears are often considered inoperable, augmented repair using an acellular dermal matrix may improve success rates. One acellular dermal matrix, AF-ADM, has shown encouraging results in an earlier case series which prompted this prospective study in an older population.
METHODS: After screening and evaluation for repair using traditional arthroscopic techniques, thirteen subjects with irreparable rotator cuff tears underwent a mini-open approach with AF-ADM augmentation. An MRI was performed for each subject preoperatively, at 3 months post-operative, and at 12 months post-operative. Clinical outcomes were assessed at 3 months, 12 months, and 24 months postoperative using the Constant-Murley Shoulder Scoring Scale, the Modified ASES, and patient satisfaction scores.
RESULTS: At 24 months follow-up, subjects demonstrated a significant 32.3 (64.4%) mean improvement in the Constant-Murley score (p=0.0001), a significant 32.5 (60.4%) mean improvement in the ASES score (p=0.0009), and a significant 31.8 mean in VAS (p=0.0011) with scores of 82.5, 86.3, and 7.4, respectively. Patient satisfaction was high at 24 months with a reported mean score of 3.4 and a median of 4.0 (out of 4). There were no complications related to graft use. Only two subjects exhibited radiographic graft failures with MRIs revealing tears in the native tissue but fully intact graft material. However, these subjects also showed excellent clinical outcome scores.
CONCLUSION: The assessments and patient satisfaction scores indicate that significant improvements can be achieved as early as three months with AF-ADM augmentation, despite the severity of these tears and age of the patients. The high success rate was especially notable as the subject group was older patients, who may have greater difficulty healing. The results presented here demonstrate that AF-ADM can be used successfully to treat massive and recurrent rotator cuff tears.
