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.

Abstract

Background: Bridging reconstruction (BRR) using human dermal allograft has emerged as a promising technique for large to massive rotator cuff tears allowing anatomical reconstruction of the rotator cuff, and preventing excessive repair tension, but little is known on the mid to long term results of this technique. The purpose of this study was to evaluate progression of rotator cuff arthropathy, graft healing, and clinical outcomes in patients following BRR for large to massive rotator cuff tears with a minimum 5-year follow-up.

Methods: A retrospective chart review of prospectively collected data was conducted for all patients who underwent BRR between 2012 and 2017. Patients who underwent BRR for large to massive rotator cuff tears and had a minimum 5-year radiographic follow-up or early re-operation were included. Patients who had a re-operation prior to the 5-year time point were included for calculation of graft failure rate, however, were excluded from the other outcome measures. The primary outcome was progression of rotator cuff arthropathy on standard radiographs at 5 years. Secondary outcome measures included acromiohumeral interval (AHI), MRI evaluation of graft healing, and Western Ontario Rotator Cuff Index (WORC) at final follow-up.

Results: Forty-five patients met inclusion criteria and were included in this study. Nine patients (20%) underwent reoperation due to graft retear before the 5-year time point and were included in the analysis of graft failure but were excluded from the x-ray and functional analysis. Thirty-six patients had radiographic follow-up at a mean 6.44 years and were included in the final analysis. Two patients (5.5%) demonstrated progression of RCA. Sixty-five percent of patients had a healed graft, 23% had a partial tear and 12% had a complete retear of the graft. The WORC scores (N=33) significantly improved from 70.1 (SD=12.87) preoperatively to 24.7 (SD=21.9) at the most recent follow-up (p<0.001). Ninety-four percent of patients achieved the MCID of the WORC score.

Conclusion: The results of this study show that bridging reconstruction with dermal allograft has promising results over a 5-year follow-up with low progression to rotator cuff arthropathy and favorable graft healing rates. Patient reported outcomes significantly improved postoperatively with 94% of patients achieving the MCID, highlighting the efficacy of this technique in preserving shoulder function and integrity.