Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder

Table 1 Results of allograft interposition

Study and graft	Number	Ave age (yr)	F/U(mo)	Outcome scorePre/post/P value	ROMPre/post/P value	Conclusion
Neviaser et al[40] Freeze dried rotator cuff	16	58	20	13/16 excellent results Criteria used: Nocturnal pain Degree of abduction	> 160:6 120-160:3 90-120:5 < 90:2 Average: 122.5	In our patients there has been no sign that the grafts were rejected and the goals of the procedure to improve motion and to relieve pain usually were attained
Nasca et al[41] Freeze dried rotator cuff	7	62	42	Good 2, fair 2, poor 3	FF: 78/90 Abd: 69.2/84	Freeze dried rotator cuff allografts do not appear to be of significant value in the surgical management of chronic massive rotator cuff tears
Venouziou et al[43] HDA	14	54.6	30.2	ASES: 23.8/72.3/P = 0.001	FF: 73.6/129.3/P = 0.002 ABD: 67.5/117.9/P = 0.002 ER: 7.9/ 43.2/P = 0.001	The ROM and the functional outcome were all improved in the patients with less than 2 cm tendon gap. In the case of larger tendon defects the outcome is unpredictable
Moore et al[12] 26 Patellar 5 Achilles 1 Quadriceps	32	59.1	31.3	UCLA: 12.1/26.1/P < 0.001 Excellent 3, good 12, fair 8, poor 5	Active FF UCLA: 3/3.8/P < 0.17 Resisted FF UCLA: 2.9/3.7/P < 0.002	15/15 showed failure on MRI. Allograft reconstruction for massive, irreparable rotator cuff tears is not recommended
Bond et al[42] HDA	16	54.4	28.8	UCLA: 18.4/30.4/P = 0.0001 Excellent 4, good 9, Fair 3, Poor 0 53.8/84/P = 0.0001	FF: 106/142/P = 0.0001 ER: 43/47.2/NR	Our study supports the hypothesis that GJA is a viable treatment option for surgical salvage in select cases of symptomatic massive, irreparable rotator cuff pathology
Gupta et al[44] HDA	24	63	36	ASES: 66.6/88.7/P = 0.003 SF-12: 48.8/56.8/P = 0.03	FF: 111.7/157.3/P = 0.0002 ABD: 105/151.7/P = 0.0001 ER: 46.2/65.1/P = 0.001	Human dermal interposition repair of massive rotator cuff tears through a mini-open approach is a reproducible technique that leads to significant improvement in pain, ROM, strength and subjective scores
Wong et al[45] HDA (Extreme)	45	53.6	24 min	UCLA: 18.4/27.5/P < 0.001 ASES: 84.1 (post)		Arthroscopic rotator cuff reconstruction with GraftJacket (Human dermal allograft) is safe and is associated with high patient satisfaction, without the morbidity of tendon transfer or arthroplasty
Ito et al[47] Allograft fascia lata	9	62.8	35	JOA: 47.9/91.7/P = 0.0059	FF: 84.4/159.6/P < 0.005 ADB: 62.2/163.3/P < 0.005 ER: 43.9/41.7/NR	Patch Grafts are considered to have the advantages of achieving anatomical repair with minimal restriction of range of motion and minimal occurrence of re-tearing
Modi el al[46] HDA	61	62.6	42	OSS: 26/42/P = 0.001	FF: 97/160/P = 0.001 ABD: 90/155/P = 0.001 ER: 42/60/0.04	GraftJacket allograft regenerative tissue matrix provides a very good option for bridging irreparable rotator cuff tears in the short to medium term

HDA: Human Dermal allograft; FF: Forward flexion; Abd: Abduction; ER: External rotation; UCLA: University of California-Los Angeles; ASES: American Shoulder and Elbow Surgeon evaluation form; JOA: Japanese Orthopaedic Association; OSS: Oxford shoulder score.