Postoperative Outcomes Following Bridging Reconstruction for Large to Massive Rotator Cuff Tears Using Two Different Dermal Allografts: A Retrospective Cohort Comparison Study.

BACKGROUND: Rotator cuff tears are common injuries that significantly impair shoulder function and quality of life, particularly for large to massive tears, where maximal repair often results in high retear rates. Bridging reconstruction using acellular dermal allografts such as GraftJacket and AlloPatch offers a promising alternative by providing a scaffold that supports tendon healing and enhances structural stability. Although these grafts have similar biomechanical strengths, they differ in processing and biological properties, and comparative clinical outcomes remain understudied.

PURPOSE: To compare radiologic and clinical outcomes of patients who underwent arthroscopic rotator cuff reconstruction using GraftJacket or AlloPatch allografts.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients who underwent arthroscopic bridging reconstruction for large to massive rotator cuff tears (>3 cm) using GraftJacket or AlloPatch were included. The primary outcome was healing assessed by magnetic resonance imaging. The secondary outcome was the Western Ontario Rotator Cuff (WORC) index. Tertiary outcomes were imaging-based structural metrics, including acromiohumeral interval (AHI), muscle atrophy (Warner grade), fatty infiltration (Goutallier-Fuchs classification), and structural integrity (Sugaya classification). Demographics, intraoperative data, and all outcome measures were compared between graft groups.

RESULTS: There were no significant demographic differences between GraftJacket (n = 49) and AlloPatch (n = 37) groups. The AlloPatch group had higher baseline supraspinatus muscle atrophy (P = .006) and fatty infiltration (P = .03) grades, along with more concurrent subscapularis repairs (P < .001). Postoperative imaging occurred at 2.22 ± 1.14 years for GraftJacket and 1.35 ± 0.70 years for AlloPatch (P < .001). Graft healing was not significantly different between groups (AlloPatch: 76%, GraftJacket: 69%; P = .52). Postoperative patient-reported outcomes were measured at 2.91 ± 0.87 years for GraftJacket and 2.64 ± 0.66 years for AlloPatch (P < .27). Both groups improved WORC scores from preoperative to postoperative assessment (P < .001), with no between-group difference (P = .97). The AlloPatch group had an increased postoperative AHI (P = .045), and the GraftJacket group did not, although the GraftJacket group had higher structural integrity (Sugaya) grades postoperatively (P = .02). No other between-group differences in imaging-based structural metrics were found.

CONCLUSION: GraftJacket and AlloPatch dermal allografts yield comparable healing, patient-reported outcomes, and structural imaging metrics following arthroscopic bridging reconstruction for large to massive rotator cuff tears, demonstrating similar efficacy.