www.amjorthopedics.com February 2013 The American Journal of Orthopedics ® 63 An Original Study Human Dermal Allograft Interposition for the Reconstruction of Massive Irreparable Rotator Cuff Tears Aaron I. Venouziou, MD, Zinon T. Kokkalis, MD, and Dean G. Sotereanos, MD C hronic massive rotator cuff tears (RCTs) represent a therapeutic challenge. In an older patient population such tears, especially when associated with gleno- humeral joint osteoarthritis, can be treated effectively with reverse shoulder arthroplasty. However, this is not an ideal option in the younger more functional age group, where the goal is to reattach the rotator cuff to the anatomic insertion on the greater tuberosity. Massive RCTs most commonly are irreparable due to atrophy, ibrosis, fatty iniltration, and severe tendon retraction. 1 In some cases the poor-quality tissue and cicatrix coupled with wide-tear margin makes surgical mo- bilization dificult and anatomical tension free repair almost impossible. 2 Open and arthroscopic anatomic repair of chronic massive RCTs have demonstrated high recurrence rate. 3-7 In order to avoid recurrence failure, numerous surgical techniques have been developed to address this issue. Partial repair of mas- sive RCTs, arthroscopic debridement of such tears and tendon transfers, such as latissimus dorsi transfer, represent alternative option for the treating surgeon. 8-13 Recently, the use of tissue-engineered biomaterials has been proposed as an alternative reconstructive procedure for the treatment of massive RCTs. Collagen patches derived from porcine small intestine submucosa have demonstrated low healing potential with high failure rate, poor functional out- comes, and aseptic drainage. 14,15 Cross-linked porcine dermis patches have also been used but the reports have demonstrated mixed results. 16,17 The acellular human dermis allograft has been used with great success for other orthopedic applications, without many of those reported complications. 18-21 Promising results were also noted after the use of this material for the reconstruction of chronic massive RCTs. 22-24 We are not aware of any study reporting on the use of acel- lular dermis allograft as an interposition device for the open reconstruction of RCTs, which are severely retracted and not capable of being mobilized. For this reason, we conducted a retrospective study to evaluate the functional outcomes of open rotator cuff reconstruction interposed by human acel- lular dermis allograft. Materials and Methods An Institutional Review Board approval was available for this study (RC-5047). A retrospective chart review of patients who had rotator cuff repair with acellular dermis allograft (Graft- Jacket; Wright Medical Technology Inc, Arlington, Tennessee) in the practice of the senior author identiied 20 such proce- dures. The criteria for inclusion were: 1) the presence of a mas- sive RCT, which was minimally or not capable of mobilization to the anatomic insertion, 2) the use of GraftJacket (Wright Medical Technology Inc) as an interposition material to bridge the gap between the tendon and the anatomic insertion of the rotator cuff, and 3) a minimum follow up time of 18 months. Cuff tears were characterized as massive intraoperatively, when their size was over 5 cm and a tension free repair was not Abstract This retrospective study sought to determine the effectiveness of the acellular human dermal al- lograft as a bridging device for reconstruction of massive irreparable rotator cuff tears (RCTs). Fourteen patients with an average age of 54.6 years underwent open reconstruction for mas- sive irreparable RCTs. Signiicant improvement was found for pain and range of motion (ROM). Patient satisfaction was high. The mean Ameri- can Shoulder and Elbow Surgeons (ASES) score improved from 23.8 points preoperatively to 72.3 postoperatively (P = .001). A signiicant correla- tion was found between the size of the tendon gap, which was bridged with the allograft, and the pain, ROM and ASES score. Patients with less than 2 cm tendon gap had a better outcome than those with greater tendon defects. Open reconstruction of chronic massive irrep- arable RCTs with human dermal allograft interpo- sition is an alternative technique with encourag- ing short-term results. Our study indicates that the dermal allograft can be used safely to bridge tendon gaps of up to 2 cm with great success. Authors’ Disclosure Statement: The authors report no actual or potential conlict of interest in relation to this article. AJO DO NOT COPY