Original article
Rotator Cuff Repair Using an Acellular Dermal Matrix Graft: An In Vivo Study in a Canine Model

https://doi.org/10.1016/j.arthro.2006.03.016Get rights and content

Purpose: Large rotator cuff tears present a challenge to orthopaedic surgeons. Because tissue may be insufficient or of inadequate quality to undergo repair, a variety of materials have been used as adjuncts. Human dermal tissue may be processed to render it acellular, and thus less immunogenic, but with the extracellular matrix left intact, creating a collagen scaffold with favorable characteristics. Because of these traits, use in rotator cuff repair was proposed. Methods: A canine model for a full-thickness infraspinatus tendon tear was used. Tendon was excised from the bony interface to the myotendinous junction, and a human acellular dermal matrix graft (experimental) or the autologous excised tendon (control) was used to bridge the defect. Animals were sacrificed, and shoulders were evaluated histologically and biomechanically. Results: At time 0, strength of control and experimental repairs was similar. At 6 weeks, the strength of the experimental repair was half that of the control side. Strength of control specimens remained the same at 6 and 12 weeks, but by 12 weeks, the strength of the experimental repair was equal to that of the control. Histologically, cells infiltrated the control and experimental specimens by 6 weeks; chronic inflammation was consistent with surgery and repair. At 6 months, control and experimental specimens mimicked normal tendon structure grossly and histologically. Conclusions: Use of human acellular dermal matrix as a patch is a viable option in this model of large rotator cuff defects. Within 6 weeks, histologic evidence of native cell infiltration and neotendon development was observed. Within 12 weeks, the strength of the dermal matrix graft repair was equivalent to that of autologous tendon. At 6 months, control and graft specimens mimicked normal tendon structure grossly and histologically. Clinical Relevance: This study provides in vivo animal data to support the use of this acellular dermal matrix graft for repair of full-thickness rotator cuff defects. Additional studies are indicated to determine the role of this material in the treatment of humans with rotator cuff tears.

Section snippets

Experimental Design

Approval for this study was obtained from our Institutional Animal Care and Use Committee (IACUC) and guidelines of the National Institutes of Health were followed. Skeletally mature mongrel dogs were used (age >12 months; weight 20 to 35 kg). Eleven animals were randomized to the histologic arm of the study, with survival times of 6 weeks (n = 3), 3 months (n = 4), and 6 months (n = 3). Each animal underwent unilateral surgery on the left shoulder. For the mechanical testing arm of the study,

Clinical Assessment

All animals were ambulatory and were bearing full weight immediately after surgery. No lameness was observed. A single case of superficial wound dehiscence was noted and was adequately managed with percutaneous bacitracin ointment. The wound granulated, and the skin healed without incident.

Gross Findings

With increasing survival time, control and dermal grafts exhibited progressive thickening and formation of a tendon-like structure. This appeared to maximize at 6 weeks (control) and at 3 months (graft);

Discussion

Management of large or massive rotator cuff defects is a difficult problem in orthopaedic practice. Cofield et al.32 investigated outcomes after rotator cuff repair and noted poorer results in patients with large or massive rotator cuff tears who had undergone repair relative to those with small or medium tears. The authors suggested that alternative techniques should be investigated for treatment of these large or massive tears because traditional methods may be less successful in these

Acknowledgments

The authors thank Steven P. Arnoczky, DVM, The Wade O. Brinker Endowed Professor of Surgery, and Director of the Laboratory for Comparative Orthopedic Research at Michigan State University College of Veterinary Medicine, for his invaluable assistance with this study.

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    Supported in part by a research grant from Wright Medical Technology, Arlington, Tennessee. Additional institutional support was provided by the Mayo Foundation, Rochester, Minnesota.

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