Enhanced Structural Outcomes With Acellular Dermal Matrix Patch Augmentation Versus Single-Row Repair in Large-to-Massive Rotator Cuff Tears: A Propensity Score-Matched Analysis

Abstract

Background: Although acellular dermal matrix (ADM) patch augmentation is known to reduce retear rates compared with repair without augmentation, clinical outcomes have varied across previous studies due to cohort heterogeneity. Hypothesis: ADM patch augmentation would lead to improved outcomes compared with single-row repair alone in a propensity score-matched cohort of patients with large-to-massive rotator cuff tear. Study Design: Cohort study; Level of evidence, 3.Methods: This retrospective study investigated patients who underwent arthroscopic rotator cuff repair for large-to-massive posterosuperior tears between March 2019 and February 2024. Propensity score matching was performed to minimize selection bias, resulting in 32 patients each in the group that had single-row repair and the group that had single-row repair with ADM patch augmentation. Clinical outcomes and range of motion were compared at the 2-year follow-up. Structural integrity was assessed using magnetic resonance imaging at the 6-month follow-up. Multivariate logistic regression was conducted on the entire cohort to quantify the efficacy of patch augmentation in improving structural integrity. Results: After propensity matching, the baseline characteristics were similar between groups. Both groups demonstrated significant improvements in clinical outcomes and range of motion compared with preoperative status (all P < .001). Clinical outcomes and range of motion did not differ significantly between groups. However, the retear rate was significantly lower in the ADM patch augmentation group (12.5%) compared with the matched single-row repair group (34.4%; P = .039). In the multivariate analysis of the entire cohort of 160 patients, ADM patch augmentation showed reduced odds of retear compared with single-row repair alone (odds ratio, 0.292; P = .013). Conclusion: In large-to-massive rotator cuff tears, ADM patch augmentation appeared to play a protective role in maintaining structural integrity. However, further studies are warranted to evaluate its long-term clinical outcomes.