Bridging reconstruction for massive rotator cuff tears has a low rate of arthritic progression and maintained excellent clinical outcomes for a minimum 5-year follow-up
Bibliographic record
Abstract
BACKGROUND: Bridging reconstruction (BRR) using human dermal allograft has emerged as a promising technique for large to massive rotator cuff tears allowing anatomic reconstruction of the rotator cuff, and preventing excessive repair tension, but little is known on the mid- to long-term results of this technique. The purpose of this study was to evaluate progression of rotator cuff arthropathy, graft healing, and clinical outcomes in patients following BRR for large to massive rotator cuff tears with a minimum 5-year follow-up. METHODS: A retrospective chart review of prospectively collected data was conducted for all patients who underwent BRR between 2012 and 2017. Patients who underwent BRR for large to massive rotator cuff tears and had a minimum 5-year radiographic follow-up or early reoperation were included. Patients who had a reoperation before the 5-year time point were included for calculation of graft failure rate but excluded from the other outcome measures. The primary outcome was progression of rotator cuff arthropathy on standard radiographs at 5 years. Secondary outcome measures included acromiohumeral interval, magnetic resonance imaging evaluation of graft healing, and Western Ontario Rotator Cuff Index (WORC) at final follow-up. RESULTS: Forty-five patients met inclusion criteria and were included in this study. Nine patients (20%) underwent reoperation because of graft retear before the 5-year time point and were included in the analysis of graft failure but were excluded from the radiographic and functional analysis. Thirty-six patients had radiographic follow-up at a mean 6.44 years and were included in the final analysis. Two patients (5.5%) demonstrated progression of RCA. Sixty-five percent of patients had a healed graft, 23% had a partial tear, and 12% had a complete retear of the graft. The WORC scores (n = 33) significantly improved from 70.1 (standard deviation [SD] = 12.87) preoperatively to 24.7 (SD = 21.9) at the most recent follow-up (P < .001). Ninety-four percent of patients achieved the Minimal Clinically Important Difference (MCID) of the WORC score. CONCLUSION: The results of this study show that BRR with dermal allograft has promising results over a 5-year follow-up with low progression to rotator cuff arthropathy and favorable graft healing rates. Patient-reported outcomes significantly improved postoperatively, with 94% of patients achieving the MCID, highlighting the efficacy of this technique in preserving shoulder function and integrity.
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".