title: Allograft reconstruction for massive, irreparable rotator cuff tears.
abstract: BACKGROUND
  There is currently no widely accepted treatment for massive, irreparable rotator cuff tears.
  
  
  OBJECTIVE
  Allograft reconstruction to span the remaining defect in massive, irreparable rotator cuff tears will lead to increased functional results and will demonstrate healing of the allograft on follow-up magnetic resonance imaging studies.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Between 1989 and 2003, 32 patients underwent allograft reconstruction of massive rotator cuff tears. University of California, Los Angeles shoulder scores were compared preoperatively and postoperatively and analyzed using paired Student t tests. In addition, 15 patients underwent postoperative magnetic resonance imaging to evaluate the structural integrity of the allograft reconstruction at the greater tuberosity insertion.
  
  
  RESULTS
  Of 32 patients, 28 were available for review at a mean follow-up of 31.3 months; 23 of the 28 patients were satisfied with their outcome. There was 1 postoperative infection and 1 acute allograft rejection. The mean University of California, Los Angeles score increased from 12.1 preoperatively to 26.1 postoperatively (P < .001). All 15 patients evaluated with postoperative magnetic resonance imaging arthrograms demonstrated complete radiographic failure of the allograft rotator cuff reconstruction. Despite radiographic failure, the mean University of California, Los Angeles score increased from 13.2 preoperatively to 28.3 postoperatively in this subset of patients.
  
  
  CONCLUSIONS
  The functional results of this reconstruction method are similar to those reported for debridement and subacromial decompression alone and are satisfactory, despite magnetic resonance imaging arthrogram evaluation demonstrating failure of the structural integrity of the allograft. Allograft reconstruction carries increased risk of infection and rejection and is technically more difficult than other less expensive treatment options with similar functional results. Therefore, we do not recommend allograft reconstruction of massive and otherwise irreparable rotator cuff tears.
authors.affiliation: Southern Medical University, Nashville, TN 37203, USA. dmoore@southernsportsmed.com
authors.forename: David R
authors.initials: DR
authors.lastname: Moore
authors.forename: E Lyle
authors.initials: EL
authors.lastname: Cain
authors.forename: Martin L
authors.initials: ML
authors.lastname: Schwartz
authors.forename: William G
authors.initials: WG
authors.lastname: Clancy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D014184:Transplantation, Homologous / Q000534:rehabilitation*