Bridging Reconstruction With Interpositional Dermal Allograft Has Superior Healing Than Does Maximal Repair for Treatment of Large to Massive, Irreparable Rotator Cuff Tears—Secondary Analysis of a Randomized Control Trial
Bibliographic record
Abstract
PURPOSE: To compare the radiographic results of bridging rotator cuff reconstruction (BRR) with dermal allograft and maximal repair for large or massive, irreparable rotator cuff tears. METHODS: This was a secondary analysis of data from a single-center, blinded-observer, randomized controlled trial that examined clinical outcomes of BRR compared with maximal repair. A sample size of 30 patients with magnetic resonance imaging (MRI)-proven large or massive (>3 cm), retracted rotator cuff tears and/or involvement of 2 or more tendons were randomly allocated to 1 of 2 groups: maximal repair or BRR using dermal allograft. MRIs were obtained preoperatively and 1 year postoperatively. The primary outcome of this study was the retear rate on MRI. Secondary outcomes included progression of muscle atrophy and fatty infiltration. RESULTS: There was no difference in age or preoperative tear size between the 2 groups. Patients treated with BRR had decreased retear rate (21%) compared with patients who received maximal repair alone (87%). There was no difference in the number of patients who had progression of muscle atrophy (P = .088 for supraspinatus and P = .738 for infraspinatus) or fatty infiltration (P = .879 for supraspinatus and P = .693 for infraspinatus) between the 2 groups. A significant increase in mean postoperative supraspinatus muscle atrophy was identified in the maximal repair group (P = .034). CONCLUSIONS: The results of this secondary analysis of a randomized controlled trial comparing radiographic results of maximal repair versus BRR using dermal allograft in the treatment of large or massive rotator cuff tears show that BRR results in a significantly reduced structural failure rate and a trend toward better preservation of supraspinatus muscle mass compared with maximal repair. LEVEL OF EVIDENCE: Level I, secondary analysis of a randomized controlled trial.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.006 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".