2019 ISAKOS Biennial Congress Paper #99
Failed Dermal Allograft Procedures for Irreparable Rotator Cuff Tears Can Still Improve Pain and Function: The "Biologic Tuberoplasty Effect"
Raffy Mirzayan, MD, Baldwin Park, CA UNITED STATES
Michael A. Stone, MD, Pasadena, CA UNITED STATES
Michael Batech, DrPH, Pasadena, CA UNITED STATES
Daniel Acevedo, MD, Calabasas, CA UNITED STATES
Anshuman Singh, MD, San Diego, CA UNITED STATES
Kaiser Permanente Southern California , Baldwin Park, CA, UNITED STATES
The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: LifeNet Health, Arthroflex
Failed SCR or Bridging procedures can still improve pain and function. The Biologic Tuberoplasty Effect
Objectives: 1. Correlate acellular dermal matrix (ADM) graft integrity used in “bridging” (BRI) and superior capsule reconstruction (SCR) procedures with functional outcomes. 2. Propose a classification for ADM tear pattern.
Between 2006 and 2016, 15 shoulders underwent BRI, and 10 shoulders underwent SCR with an ADM. Pre- and postoperative visual analogue scale (VAS), American Shoulder and Elbow Scores (ASES), Hamada grade, and Goutallier classification were reviewed. A post-operative MRI was available in 22 (88%) shoulders. The status of the graft was divided into: Type I – graft intact medially and laterally (fully healed); Type II- torn mid-substance; Type III – graft torn medially; Type IV – graft torn laterally; Type V – graft absent (dissolved).
The average age was 61 years (range: 49-73 years). Average follow up was 21.6 months (range 8-80 months). Average length from surgery to post-operative MRI was 13.9 months (range 6-80 months). Overall tear rate was 59% (13 of 22). Tear rate in BRI was 42% (5 of 12), and in SCR 80% (8 of10). There were significant improvements in VAS and ASES (8.1 to 1.3 and 26.3 to 84.6, respectively; p<0.01) in Type I grafts, and in VAS and ASES (7.0 to 0.7 and 32.6 to 91.2, respectively; p<0.01) in Type II and III graft tears. There was no difference in postoperative VAS and ASES (1.3 versus 0.7 and 84.6 versus 91.2, respectively; p=0.8) between Type I versus Type II and III graft tears. There was no improvement in VAS (7.3 versus 5.7, P=0.2) and ASES (30.6 versus 37.2, P=0.5) in Type IV and V graft tears. There was a significant difference in postoperative VAS (5.7 versus 1) and ASES (37.2 versus 88.1) between Type IV and V versus Types II, III, and I respectively (p<0.01).
Functional improvement is achieved if the ADM has healed to the tuberosity, regardless if it is still intact medially.
Level of Evidence: IV