Limited evidence supports the use of dermal allografts to augment the repair of large and massive rotator cuff tears to improve patient reported outcomes.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Limited Evidence LIMITED EVIDENCE
Rationale
There was one moderate strength study (Barber et al. 2016) and one low strength studies (Gilot et al. 2015).  The remainder of published studies either had too few subjects (<20) or involved interpostion rather than augmentation of rotator cuff repair.  Barber et al., in a moderate quality study, involved a comparison of two-tendon three-centimeter tears with or without an acellular human dermal matrix allograft augmentation.  Both Constant scores and re-tear rates were significantly improved with use of the allograft augmentation, with no adverse events related to the allograft.  Gilot et al. in a low quality study of 20 acellular dermal matrix augmented repairs versus 15 unaugmented repairs, noted a significantly decreased rate of retears and significantly improved outcome scores with augmented repairs. There were no graft related complications in the study of Gilot.

Risks and Harms of Implementing this Recommendation
The use of dermal allografts increases operating time and thus may increase infection rates and other surgical time-related complications.  Use of dermal allografts will also substantially increase the cost of rotator cuff surgery.

Future Research
Given the risks and costs involved with these devices, high quality studies would be useful to definitively establish the benefits of these device.
 
  1. Barber, F. A. Triple-Loaded Single-Row Versus Suture-Bridge Double-Row Rotator Cuff Tendon Repair With Platelet-Rich Plasma Fibrin Membrane: A Randomized Controlled Trial. Arthroscopy 2016; 5: 753-61
  2. Gilot, G. J., Alvarez-Pinzon, A. M., Barcksdale, L., Westerdahl, D., Krill, M., Peck, E. Outcome of Large to Massive Rotator Cuff Tears Repaired With and Without Extracellular Matrix Augmentation: A Prospective Comparative Study. Arthroscopy 2015; 8: 1459-65