JSES - 2026-03-19 - Journal Article
Patch Augmentation for Large-to-Massive Rotator Cuff Tears: Heal well in Anterior Cable Disruption?
Jung JW, Kim HH, Rathod P, Rhee YG
Topics
Key Takeaway
HDA patch augmentation for large-to-massive rotator cuff tears yields a 7.7% overall retear rate at mean 39 months with no significant difference between intact anterior cable (6.1%) and disrupted anterior cable (10.3%) groups.
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Summary
This study asked whether anterior cable disruption negates the benefit of HDA augmentation in arthroscopic repair of large-to-massive rotator cuff tears. Seventy-eight patients were divided into intact cable (Group A, n=49) and disrupted cable (Group B, n=29) cohorts and followed a minimum of 24 months. Both groups achieved equivalent improvements in VAS, ASES, and UCLA scores with MCID attainment rates of 85–97.5%, and retear rates of 6.1% vs. 10.3% (P=0.665).
Key Limitation
The disrupted cable group (n=29) is underpowered to detect a clinically meaningful difference in retear rate between groups, and the 10.3% vs. 6.1% absolute difference cannot be dismissed as equivalent without an adequately powered analysis.
Original Abstract
BACKGROUND
Previous studies have reported that human dermal allograft (HDA) augmentation can improve clinical outcomes and reduce retears in large-to-massive rotator cuff tears (LMRCTs). However, its effectiveness in cases with anterior cable disruptions has not been well established. The purpose of this study was to evaluate whether patch augmentation is still effective in the presence of anterior cable disruption.
METHODS
We retrospectively reviewed patients who underwent arthroscopic repair with HDA augmentation for repairable LMRCTs between March 2020 and May 2023. Patients were divided into two groups according to the integrity of the anterior rotator cable, including intact cable group (Group A) and the anterior cable disruption group (Group B). Patients with a minimum of 24 months of follow-up were included. Clinical outcomes were assessed using the visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), University of California, Los Angeles (UCLA) score, and range of motion (ROM). Structural evaluations included the acromiohumeral interval (AHI), combined tendon-graft thickness, and retear rate.
RESULTS
A total of 78 patients were included with a mean follow-up of 39.0 months (range, 25.2-56.1 months). The mean age was 64.7 years (range, 44-82 years), and 35 patients (44.9%) were male. Both groups demonstrated significant postoperative improvement in VAS (P < .001), ASES (P < .001), and UCLA scores (P < .001) with no significant difference between groups. Overall, 92.5% of patients achieved the minimum clinically important difference (MCID) for VAS, 85.0% for ASES, and 97.5% for UCLA scores, with no significant differences between groups (P > .05). Postoperative active ROM, including forward flexion, external rotation, and abduction, improved significantly in both groups (all P < .05) with no significant intergroup differences (all P > .05). The AHI increased significantly in both Group A (from 8.8 to 9.7 mm; P < .001) and Group B (from 8.5 to 9.7 mm; P < .001). Follow-up MRI demonstrated a significant decrease in combined tendon-graft thickness, with a mean reduction of 29% (from 8.0 to 5.6 mm; P < .001). The overall retear rate was 7.7% (6 of 78 patients), with no significant difference between Group A (6.1%) and Group B (10.3%) (P = .665).
CONCLUSIONS
Arthroscopic rotator cuff repair with HDA augmentation for LMRCTs resulted in improved clinical outcomes and a low retear rate regardless of anterior cable integrity. The postoperative increase in AHI suggests improved glenohumeral joint stability following restoration of rotator cuff function. These results indicate that patch augmentation is a viable treatment option for repairable LMRCTs with anterior cable disruption.