DERMAL ALLOGRAFTS

Two moderate strength studies (Barber, 2012; Lee, 2022) and one small, but high-quality study (Snow 2023) support the use of human dermal allograft for rotator cuff augmentation. The remainder of published studies either had too few subjects (<20) or involved interposition 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. Snow performed a pilot study with 20 patients in each group, suggesting a lower retear rate (Sugiya 4-5) in rotator cuff repair augmented with human dermal allograft. Meta-analysis of high quality and moderate quality studies of porcine allograft suggest no benefit for either retear rate or patient-reported outcome measures.

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 may 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 devices.