Patch augmentation for large-to-massive rotator cuff tears: do they heal well in anterior cable disruption?

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. We retrospectively reviewed patients who underwent arthroscopic repair with HDA augmentation for repairable LMRCTs between March 2020 and May 2023. Patients were divided into 2 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. Structural evaluations included the acromiohumeral interval (AHI), combined tendon-graft thickness, and retear rate. 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 minimal clinically important difference for VAS, 85.0% for ASES, and 97.5% for UCLA scores, with no significant differences between groups (P > .05). Postoperative active range of motion, 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 magnetic resonance imaging 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). 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.