Arthroscopic Biologic Tuberoplasty With a Dermal Allograft Leads to Significant Improvement in Functional Outcomes in Patients With Massive, Irreparable Rotator Cuff Tears.

PURPOSE: To present outcomes of patients who underwent arthroscopic biologic tuberoplasty (ABT) and evaluate differences in outcomes based on sex, Hamada grade, concomitant procedures, and length of follow-up with a minimum of 1-year follow-up.

METHODS

Patients who underwent ABT between 2015 and 2022, with a minimum 1-year follow-up, were identified. Inclusion criteria were: (1) massive, irreparable rotator cuff tears, (2) active forward elevation >900, (3) intact or reparable upper border subscapularis tear, and (4) Hamada 1 to 3. ABT was performed with a 3- mm-thick dermal allograft. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale for pain were recorded.

RESULTS

Fifty patients (68% males) met the inclusion criteria. Mean follow-up was 22.9 ± 15.7 months (range: 12-109 months). The mean age was 64.8 ± 8.1 years (range: 46-79 years). There was a significant improvement in ASES (37.4 ± 14.1-85.8 ± 10.5, P < .0001), SANE (36.3 ± 16.7-83.5 ± 10.1, P < .0001), and Visual Analog Scale for pain (7.2 ± 1.8-1.4 ± 1.9, P < .0001). There was no significant difference in mean postoperative ASES based on sex (P = .6623), Hamada grade (P = .1098), and isolated ABT versus those with concomitant procedures (P = .1087). In addition, there was no difference in postoperative ASES between patients who had 1-year follow-up, those with 1 to 2 years follow-up, and those with >2 years follow-up (P = .3887). Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state for ASES were 100%, 96%, and 80%, respectively, for SANE were 96%, 78%, and 46%, respectively, and for Visual Analog Scale were 98%, 84%, 92%, respectively. The maximal outcome improvement for ASES was 77.4 and for SANE was 74.1.

CONCLUSIONS

Excellent clinical outcomes can be achieved in patients undergoing ABT with significant functional improvement and pain reduction in patients with massive, irreparable rotator cuff tears. These outcomes can be equally achieved in males and females, and in shoulders that are Hamada 1 to 3. Outcomes of patients with >2 years follow-up were similar to those with 1-year follow-up and 1 to 2 years follow-up.

LEVEL OF EVIDENCE: Level IV, retrospective case series.