Clinical and Radiological Outcomes of Partial Rotator Cuff Repair with Acellular Dermal Patch Augmentation
DOI:
https://doi.org/10.63403/re.v33i2.488Keywords:
rotator cuff injury, arthroscopic surgical procedures, acelullar dermal patch, shoulder, Arthroscopic TreatmentAbstract
Introduction: massive rotator cuff tears are a common cause of pain and functional disability. Although arthroscopic repair aims to restore shoulder biomechanics, its results may be limited by tendon quality and muscle retraction. In this context, augmentation with acellular dermal patch (ADP) has emerged as a strategy aimed at improving structural stability and promoting healing.
Objectives: to evaluate the clinical and radiological results of partial rotator cuff repair with ADP augmentation in patients with massive but repairable tears.
Materials and methods: observational case series study including 18 patients undergoing partial rotator cuff repair with ADP augmentation. All patients completed a preoperative evaluation and postoperative follow-up at 1 month and at 2, 3, 6, and 12 months. Sociodemographic variables, range of motion, visual analog scale (VAS) for pain, and American Shoulder and Elbow Surgeons (ASES) scores were recorded. Radiological analysis was performed using magnetic resonance imaging, with preoperative assessment of the number of tendons involved, acromiohumeral distance, and Hamada, Goutallier, and Patte classifications. During follow-up, structural changes and rotator cuff integrity were evaluated, with re-tearing defined as repair failure.
Results: VAS decreased from 7 to 2, while ASES score increased from 55.8 to 85.2 points in one year of followup. Anterior flexion increased significantly from the second month and abduction from the third month. Anterior elevation showed an initial decrease followed by a sustained increase from the third month. The acromiohumeral distance increased from 6.8 to 8.0, and progression from Goutallier I to II of the supraspinatus was evident. Structural integrity was maintained in most cases, with a re-tear rate of 22%.
Conclusion: partial rotator cuff repair with ADP augmentation is a safe and effective alternative for massive but repairable tears, associated with significant improvement in pain, function, and mobility, with favorable structural preservation at one year of follow-up.
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References
Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8(4):296-299. doi: https://www.doi.org/10.1016/s1058-2746(99)90148-9.
Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001;10(3):199-203. doi: https://www.doi.org/10.1067/mse.2001.113086.
Burkhart SS, Esch JC, Jolson RS. The rotator crescent and rotator cable: an anatomic description of the shoulder's "suspension bridge". Arthroscopy. 1993;9(6):611-616. doi: https://www.doi.org/10.1016/s0749-8063(05)80496-7.
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;(304):78-83.
Barber FA, Burns JP, Deutsch A, Labbé MR, Litchfield RB. A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthroscopy. 2012;28(1):8-15. doi: https://www.doi.org/10.1016/j.arthro.2011.06.038.
Kuechly HA, Kurkowski SC, Taleghani ER, Shah NS, Kloby MA, Foster TS, et al. Ultrasound and patient-reported outcomes of rotator cuff repair with new acellular human allograft at 6 months and 1 year post surgery. JSES Rev Rep Tech. 2024;4(3):413-418. doi: https://www.doi.org/10.1016/j.xrrt.2024.03.012.
Shah D, Rathod M, Tiwari A, Kini A, Bhagunde P, Bagaria V. A histological and biomechanical analysis of Human Acellular Dermis (HAD) created using a novel processing and preservation technique. Indian J Orthop. 2024;58(7):922-931. doi: https://www.doi.org/10.1007/s43465-024-01181-9.
Nuvoli N, Troiano E, Masini A, Colasanti GB, Mondanelli N, Giannotti S. Biological patch in the repair of rotator cuff tears: functional and clinical evaluation of twenty-three cases with a mean follow-up of six years. J Clin Med. 2024;13(18):5596. doi: https://www.doi.org/10.3390/jcm13185596.
Merolla G, Bonfatti R, Marra F, Pellegrini A, Cataldo G, Saporito M, et al. Human dermal allograft augmentation in primary and revision arthroscopic rotator cuff repair: a retrospective controlled study including patient outcomes and ultrasound evaluation of tendon healing. Int Orthop. 2025;49(6):1427-1438. doi: https://www.doi.org/10.1007/s00264-025-06502-7.
Karpyshyn J, Kizaki K, Ma J, Licht F, Wong I. Bridging reconstruction for massive rotator cuff tears has a low rate of arthritic progression and maintained excellent clinical outcomes for a minimum 5-year follow-up. J Shoulder Elbow Surg. 2025;34(11):2561-2570. doi: https://www.doi.org/10.1016/j.jse.2025.01.051.
Kim SH, Shin SJ. No difference in clinical outcomes following repair of large retracted anterior rotator cuff tears using patch augmentation with human dermal allograft versus anterior cable reconstruction with biceps tendon autograft. arthroscopy. 2024;40(2):294-302. doi: https://www.doi.org/10.1016/j.arthro.2023.08.077.
Da Silva AZ, Mizels J, Clinker CE, Yoo M, Nelson R, Joyce C, et al. Cost analysis of dermal allograft patch utilization in rotator cuff repair. JSES Rev Rep Tech. 2024;5(1):40-45. doi: https://www.doi.org/10.1016/j.xrrt.2024.08.011.
Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D, et al. The CARE guidelines: consensus-based clinical case reporting guideline development. Headache. 2013;53(10):1541-1547. doi: https://www.doi.org/10.1111/head.12246.
Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears: a long-term observation. Clin Orthop Relat Res. 1990;(254):92-96.
Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res. 1990;(254):81-86.
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;(304):78-83.
Sugaya H, Maeda K, Matsuki K, Moriishi J. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy. 2005;21(11):1307-1316. doi: https://www.doi.org/10.1016/j.arthro.2005.08.011.
Lee SC, Williams D, Endo Y. The repaired rotator cuff: MRI and Ultrasound Evaluation. Curr Rev Musculoskelet Med. 2018;11(1):92-101. doi: https://www.doi.org/10.1007/s12178-018-9463-6.
Asociación Médica Mundial. Declaración de Helsinki de la AMM: principios éticos para las investigaciones médicas en seres humanos. En: 75a Asamblea General; 2024 Oct; Helsinki. Finlandia. Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/#
Krishnan P, Koh J, Pradhan S, Bobko A, Athiviraham A, Amirouche F. Analysis of abduction moment arms after rotator cuff tear and acellular dermal matrix allograft reconstruction. J Shoulder Elbow Surg. 2023;32(11):2207-2213. doi: https://www.doi.org/10.1016/j.jse.2023.04.031.
Yoo SJ, Kim BS, Kim HH, Choi S. Clinical and radiologic outcomes of augmented partial repair with acellular dermal allograft and superior capsular reconstruction in massive rotator cuff tears: 2-year follow-up. J Clin Med. 2025;14(1):219. doi: https://www.doi.org/10.3390/jcm14010219.
Liem D, Lichtenberg S, Magosch P, Habermeyer P. Magnetic resonance imaging of arthroscopic supraspinatus tendon repair. J Bone Joint Surg Am. 2007;89(8):1770-1776. doi: https://www.doi.org/10.2106/JBJS.F.00749.
Gladstone JN, Bishop JY, Lo IK, Flatow EL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med. 2007;35(5):719-728. doi: https://www.doi.org/10.1177/0363546506297539.
Melis B, DeFranco MJ, Chuinard C, Walch G. Natural history of fatty infiltration and atrophy of the supraspinatus muscle in rotator cuff tears. Clin Orthop Relat Res. 2010;468(6):1498-1505. doi: https://www.doi.org/10.1007/s11999-009-1207-x.
Pradhan A, Kumar K, Haddon A, Brownson P, Singh H. Surgical management of irreparable rotator cuff tears: a survey of current practice and literature review. Cureus. 2024;16(8):e67907. doi: https://www.doi.org/10.7759/cureus.67907.
Choi S, Kim G, Lee Y, Kim BG, Jang I, Kim JH. Patch augmentation does not provide better clinical outcomes than arthroscopic rotator cuff repair for large to massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2022;30(11):3851-3861. doi: https://www.doi.org/10.1007/s00167-022-06975-8.
Kantanavar R, Lee IE, Rhee SM, Rhee YG. Outcomes of arthroscopic single-row repair alone vs. repair with human dermal allograft patch augmentation in patients with large to massive, posterosuperior rotator cuff tears: a retrospective comparative study. J Shoulder Elbow Surg. 2024;33(4):823-831. doi: https://www.doi.org/10.1016/j.jse.2023.08.002
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Copyright (c) 2026 David Torres Manrique, Christian Lozano Lurita, Diego Maticorena Quevedo, Julio Guillén Morales, Lyl Torres López, Rodrigo A. Salinas
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