Arthroscopic Rotator Cuff Repair, Manipulation Under Anesthesia, and Capsular Release for Concurrent Rotator Cuff Tear and Adhesive Capsulitis Maintain Improvements in Outcomes and Range of Motion at Minimum 5-Year Follow-Up.

Purpose: To characterize the outcomes and range of motion at a minimum 5-year follow-up in patients undergoing arthroscopic rotator cuff repair (ARCR) with simultaneous manipulation under anesthesia (MUA) and capsular release (CR) for concurrent RC and adhesive capsulitis and to compare active range of motion of the operative and nonoperative shoulder. Methods: Patients undergoing ARCR with MUA and CR by a single surgeon were retrospectively reviewed and prospectively evaluated at a minimum of 5 years postoperatively. Standardized surveys, examinations, and patient-reported outcomes were recorded pre- and postoperatively. Outcome measures included range of motion, American Shoulder and Elbow Surgeon Score (ASES), visual analog score (VAS) for pain, Simple Shoulder Test (SST), subjective shoulder value (SSV), functional level, and satisfaction. Results: Fourteen consecutive patients were evaluated at 7.5 ± 1.6 years' follow-up. At final follow-up, the affected shoulder had substantial improvements in ASES (P < .001), VAS (P < .001), SST (P = .001), and SSV (P < .001), with similar ASES, VAS, SST, and SSV compared with the contralateral side. Range of motion was also similar to the contralateral side at final follow-up for forward elevation and internal rotation, but external rotation was noted to be 10.77 ± 17.06° (95% confidence interval 0.46-21.08, P = .042) more limited. Two patients (14%) underwent revision MUA and CR for stiffness at 6 months and 12 months' postoperatively. Conclusions: This study highlights significantly improved and maintained patient-reported outcomes and range of motion at minimum 5-year follow-up in patients undergoing concomitant ARCR, MUA, and CR. These results provide further evidence that preoperative stiffness in the setting of rotator cuff tear can be managed concurrently; however, patients may remain at an increased risk for recurrent stiffness and external rotation loss. Level of Evidence: Level IV, therapeutic case series.

Similar Value Demonstrated in the Short-Term Outcomes of Superior Capsular Reconstruction and Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears.

Purpose: The purposes of this study were to investigate the difference in value (benefit to cost ratio) of dermal allograft superior capsular reconstruction (SCR) versus reverse total shoulder arthroplasty (rTSA) for the treatment of massive rotator cuff tears (MRCTs) without arthritis; to compare the patient populations selected for the operations and report pre- and postoperative functional data; and to understand other characteristics of the 2 operations, including operating time, use of institutional resources, and complications. Methods: A retrospective, single-institution analysis during the study period 2014-2019 with MRCT treated with SCR or rTSA by 2 surgeons with complete institutional cost data and minimum 1-year clinical follow-up with American Shoulder and Elbow Surgeons (ASES) score. Value was defined as ΔASES/(total direct costs/$10,000). Results: Thirty patients underwent rTSA and 126 patients SCR during the study period with significant differences noted in patient demographics and tear characteristics between the groups (patients who underwent rTSA were older, less male, had more pseudoparalysis, had greater Hamada and Goutallier scores, and had more proximal humeral migration). Value was 25 and 29 (ΔASES/$10,000) for rTSA and SCR, respectively (P = .7). The total costs of rTSA and SCR were $16,337 and $12,763, respectively (P = .7). Both groups experienced substantial improvements in ASES scores: 42 for rTSA vs 37 for SCR (P = .6). The operative time for SCR was much longer (204 vs 108 minutes, P < .001) but complication rate lower (3% vs 13%, P = .02) versus rTSA. Conclusions: In a single institutional analysis of the treatment of MRCT without arthritis, rTSA and SCR demonstrated similar value; however, the value calculation is highly dependent on institution specific variables and duration of follow-up. The operating surgeons demonstrated different indications in selecting patients for each operation. rTSA had an advantage over SCR in shorter operative time, whereas SCR demonstrated a lower complication rate. Both SCR and rTSA are demonstrated to be effective treatments for MRCT at short-term follow-up. Level of Evidence: III, retrospective comparative study.

Prospective 1-Year Outcomes Are Maintained at Short-Term Final Follow-Up After Superior Capsular Reconstruction Augmentation of Complete Rotator Cuff Repair.

PURPOSE: To evaluate the outcomes of arthroscopic superior capsular reconstruction (SCR) augmentation of complete, massive rotator cuff repair (RCR). METHODS: A retrospective study of dermal allograft SCR-augmented RCRs performed by a single surgeon from June 2016 through December 2017 was performed with the following inclusion criteria: massive rotator cuff tear amenable to complete repair but with poor-quality native rotator cuff tissue. Radiographic follow-up was performed at 1 year, and clinical follow-up was performed at both 1 year and a minimum 2 years after surgery. Clinical follow-up included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, Subjective Shoulder Value score, active forward elevation, and external rotation. Radiographs and magnetic resonance imaging (MRI) scans were assessed for muscle quality using the Goutallier classification, and graft and cuff integrity was assessed according to the Sugaya classification. RESULTS: The inclusion criteria were met by 24 patients at 1 year and by 18 (75%) at a minimum of 2 years postoperatively. Patient-reported outcomes were improved compared with preoperative data and were maintained at minimum 2-year follow-up, with median American Shoulder and Elbow Surgeons scores of 42.5 (interquartile range [IQR], 30.8-58.7) versus 93.9 (IQR, 82.4-100) (P < .001); median Subjective Shoulder Value scores of 30 (IQR, 20-50) versus 90 (IQR, 86.2-97.2) (P < .001); and median visual analog scale pain scores of 5.5 (IQR, 1-9) versus 0 (IQR, 0-0.8) (P = .001). Evaluation of graft and tendon healing on postoperative MRI revealed poor interobserver agreement and showed 10 completely healed grafts (42%), 9 partially healed grafts (38%), and 5 completely disrupted grafts (21%), with 42% of supraspinatus tendons and 54% of infraspinatus tendons healed. CONCLUSIONS: SCR with dermal allograft augmentation of complete RCR with poor-quality tissue shows very good clinical outcomes at minimum 2-year follow-up. Poor interobserver agreement regarding postoperative graft and rotator cuff integrity by MRI was found. The healing rate for the SCR grafts was 79%. The rates of healing of the native supraspinatus and infraspinatus tendons were 42% and 54%, respectively. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Shoulder arthroscopy: a bridge from the past to the future.

This article constitutes the text of the Codman Lecture, delivered by the author to the attendees of the International Congress of Shoulder and Elbow Surgeons on September 19, 2019, in Buenos Aires, Argentina.

Successful Revision Arthroscopic Rotator Cuff Repair Is Possible in the Setting of Prior Deep Infection.

PURPOSE: To report on clinical outcomes of revision arthroscopic rotator cuff (RC) repair in the setting of prior deep infection. METHODS: A retrospective review was conducted of a single surgeon's experience treating patients with deep infection after RC repair. Pain by visual analog scale (VAS), American Shoulder Elbow Society (ASES), Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores, as well as active range of motion, were collected preoperatively and at final follow-up. RESULTS: Three patients age 54.0 ± 7.5 years, mean ± standard error of the mean) with mean follow-up of 62 months (range 24 to 83) were treated for deep infection after RC repair. Improvements were observed in all subjective and objective outcomes; VAS pain (5.0 ± 0.6 vs 0.3 ± 0.3, P = .005), ASES score (37.2 ± 4.0 vs 93.9 ± 6.1, P = .003), and active forward elevation (68.3° ± 28.5° vs 173.3° ± 6.7°, P = .06.) Excellent outcomes in SST (mean 11.3 ± 0.7) and SANE (95.0 ± 5.0) scores were also observed. No recurrent infections were noted at final follow-up. CONCLUSION: Arthroscopic reconstruction of the RC is a feasible goal in the setting of prior deep infection. When a thorough arthroscopic debridement can be achieved, it is possible to address residual RC tears with either revision repair or allograft reconstruction with the possibility of excellent short-term clinical outcomes. LEVEL OF EVIDENCE: Level IV, retrospective case series.

The Basis of Innovation: Depth, Breadth, and Tenacity.

The transition from open shoulder surgery to arthroscopic shoulder surgery represents a classic paradigm shift. In order for that paradigm shift to have occurred, the early pioneers in this discipline had to assume several burdens of their new craft: the burden of "arthroscopic identification"; the burden of developing the language of arthroscopy; the burden of disseminating arthroscopic knowledge; the burden of developing safe arthroscopic instruments and implants; and the burden of proving biomechanical and structural equivalency between arthroscopic and open constructs. Embracing these obligations, they were able to produce the paradigm shift to arthroscopic shoulder surgery through a spirited mix of depth, breadth, and tenacity, defying long odds and conventional wisdom while creating a major breakthrough in shoulder surgery.

Superior Capsular Reconstruction for the Operatively Irreparable Rotator Cuff Tear: Clinical Outcomes Are Maintained 2 Years After Surgery.

PURPOSE: To evaluate the results of arthroscopic superior capsular reconstruction (SCR) after 2-year minimum follow-up and to compare the results with those seen in a previously studied group of patients at 1 year postoperatively. METHODS: The retrospective study period was October 2014 through September 2016. Inclusion criteria were arthroscopic dermal allograft SCR performed for operatively irreparable posterosuperior rotator cuff tear with intact or repairable subscapularis tendon, failure of nonoperative treatment, and clinical follow-up at 1 and minimum 2 years postoperatively. Patients lost to follow-up or undergoing revision of the SCR were excluded from the analysis. The primary outcome measure was American Shoulder and Elbow Surgeons (ASES) score (mean, [95% confidence interval], P value). Secondary outcomes included visual analog pain rating (0-10), subjective shoulder value, and active forward elevation and external rotation (degrees). Radiographic analysis included acromiohumeral interval (millimeters) and graft integrity 1-year postoperation. Complications and reoperations were reviewed from the medical record. RESULTS: Forty-one patients met inclusion criteria at mean 34 months postoperatively, and 8 were excluded. ASES score improved from 52 (46-57) preoperative to 90 (87-92; P < .0001) and 89 (86-92; P < .0001) at 1-year postoperation and at final follow-up without diminishing in the interim (P = .9). All secondary clinical outcomes improved from preoperative to final follow-up. Subjective shoulder value diminished 5% between 1 year and final follow-up (P = .03), whereas active external rotation improved 11° during this time (P = .02). In total, 85% of grafts were fully healed, with acromiohumeral interval improved from 7 (6-8) mm to 8 mm (7-9; P = .04). There were 2 (5%) revisions and 6 (14%) failures to reach the minimally clinically important improvement in ASES score: a 19% rate of unsatisfactory outcomes. There was an additional 1 reoperation (2%) and 1 (2%) medical complication. CONCLUSIONS: Arthroscopic joint preservation surgery for massive, operatively irreparable posterosuperior rotator cuff tears with dermal allograft SCR and associated procedures results in improved clinical outcomes that are durable between 1 and minimum 2-year follow-up. LEVEL OF EVIDENCE: IV retrospective case series.

The Histology of a Healed Superior Capsular Reconstruction Dermal Allograft: A Case Report.

Acellular human dermal allograft commonly is used in the surgical treatment of complex rotator cuff tears, but little information is known about the biological fate of these grafts in human subjects. In this case report, the authors describe a patient who presented with a radiographically healed acellular human dermal allograft superior capsular reconstruction but had humeral head avascular necrosis. The healed superior capsular reconstruction, including graft-bone interfaces, was explanted after 7 months and sent for histologic analysis. A successful biological reconstruction of the superior capsule was found. The graft demonstrated gross and microscopic incorporation with the host, including a tendon-like structure, aligned collagen fibers, fibroblast-like cells, and no clear graft-host distinction. Cellular infiltration ranged from 5% to 14% (central graft) to 65% to 92% (sutured attachment points). Neovascularization and active graft remodeling were confirmed histologically. LEVEL OF EVIDENCE: V, case report.

Does an Increased Critical Shoulder Angle Affect Re-tear Rates and Clinical Outcomes Following Primary Rotator Cuff Repair? A Systematic Review.

PURPOSE: To determine if an increased critical shoulder angle (CSA) predisposes patients to higher re-tear rates and worse clinical outcomes after rotator cuff (RC) repair. METHODS: A comprehensive search of the PubMed, MEDLINE, and EMBASE databases was performed in October 2018 for English-language studies pertaining to RC repair and an increased CSA in accordance with Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines. Studies of all levels of evidence were included provided that any outcomes, including pain, patient-reported outcomes, and re-tear rates, were reported. RESULTS: Of a group of 1126 studies that satisfied the initial search criteria, 6 studies were included in the final analysis, comprising data from 473 patients. Three comparative studies were assessed for an association between increased CSA and RC re-tear rates. Among these 3 studies that compared RC re-tear rate in patients with larger and smaller CSAs, 22 of 97 patients (23%) with a larger CSA had a RC re-tear in comparison to 10 of 99 patients (10%) with a smaller CSA. All 3 studies demonstrated higher RC re-tear rates in patients with larger CSAs (risk ratio, 2.39-9.66, I2 = 7%.) The mean CSA in those patients who did not have RC re-tears ranged from 34.3° to 37°, and the mean CSA in those patients who had RC re-tears ranged from 37° to 40°. CONCLUSION: RC re-tear rates were higher in patients with larger CSAs among comparative, nonrandomized studies. However, the heterogeneity of the relevant literature limits the strength of his observation. Based on the current literature, it remains unclear as to whether lateral acromioplasty affects clinical outcomes as a function of a reduced postoperative CSA. LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.

Arthroscopic Rotator Cuff Repair in 2019: Linked, Double Row Repair for Achieving Higher Healing Rates and Optimal Clinical Outcomes.

The primary aim of rotator cuff repair surgery is to restore the musculotendinous units by creating a complete, tension-free repair construct that optimizes conditions for tendon-to-bone healing. There are many factors outside the control of the surgeon that are capable of affecting the healing process; however, there are also a number of important technical considerations that the surgeon can control, including familiarity with methods to deal with immobile tissues and techniques to perform novel repair constructs. It is clear that linked double row repairs are more likely to heal, and healed rotator cuff repairs best restore shoulder strength, improve patients' satisfaction, and maximize functional outcomes.

Hill-Sachs Lesion Classification by the Glenoid Track Paradigm in Shoulder Instability: Poor Agreement Between 3-Dimensional Computed Tomographic and Arthroscopic Methods.

PURPOSE: The purpose of this study was to determine the amount of agreement between preoperative 3-dimensional computed tomographic (3D-CT) and intraoperative arthroscopic classification of Hill-Sachs lesions (HSLs) according to the glenoid track (GT) paradigm. METHODS: Records for patients treated surgically for anterior shoulder instability from a single surgeon's practice from August 2013 until March 2016 were retrospectively reviewed. Inclusion criteria were presence of an HSL, < 25% glenoid bone loss, bilateral 3D-CT, and arthroscopically recorded bone loss measurements. Records for patients with chronic dislocations or prior operations were excluded. Calculations by 3D-CT and arthroscopy were performed as follows: Hill-Sachs interval (HSI) was the distance from rotator cuff insertion to medial edge of the HSL; GT was 83% of the normal glenoid width minus any glenoid defect; on-track was HSI less than GT; off-track was HSI greater than GT. RESULTS: Sixteen shoulders with HSL status determined as on- or off-track demonstrated agreement between the 2 methods in 10 of 16 cases (63%, Cohen's κ = 0.16). All 6 cases with disagreement were calculated as on-track by 3D-CT and off-track by arthroscopic measurement. The GT was larger as determined by 3D-CT measurement (22 ± 1 mm [21-24]) compared with arthroscopy (18 ± 1 mm [17-20], P = .002). CONCLUSIONS: Preoperative 3D-CT showed slight agreement compared with intraoperative arthroscopic measurements in classifying HSL as on-track versus off-track in the GT paradigm; larger GT size by 3D-CT versus arthroscopy accounted for all discrepancies. Determination of off-track status based on preoperative 3D-CT versus determination with the arthroscopic method would result in fewer HSLs treated with remplissage if the GT treatment paradigm were followed. Surgeons using the GT paradigm to determine treatment of HSL by remplissage should recognize the potential for discordance between arthroscopic and radiographic measurements.

Arthroscopic Rotator Cuff Repair: How to Avoid Retear.

A healed rotator cuff repair results in a superior outcome for the patient compared with a non-healed repair. The surgeon can maximize the chance of a healed repair by knowing the end-point of each key step in the repair process and adhering to a few core principles. First, the rotator cuff tear pattern (e.g. crescent, L-tear, reverse L-tear, U-tear) must be recognized, starting with careful assessment of preoperative MRI but concluding with the arthroscopic assessment of tear edge mobility. Second, a low-tension, anatomic, and mechanically robust repair construct (e.g. linked, double row; load-sharing rip stop; margin convergence to bone) must be determined based on the tear pattern. Increasingly, surgeons are recognizing the importance of the superior capsule of the shoulder, which can appear as a separate pathoanatomic structure in a delaminated rotator cuff tear and require independent suturing in the repair construct. Third, the biological healing capacity of the repair site must be optimized by using meticulous preparation of the greater tuberosity bone, including removal of soft tissue remnants, light burring, and creation of bone vents. Finally, avoid aggressive early rehabilitation after arthroscopic rotator cuff repair respecting that tendon to bone healing is unlikely to occur before 12 weeks postoperatively. Sling immobilization and judicious use of early passive motion should be used for the first 6 weeks, with passive shoulder range of motion performed during weeks 6-12 postoperatively. Rotator cuff strengthening, and active overhead use of the arm should be delayed until at least 12 weeks after surgery to minimize the risk of retear.

Superior Capsular Reconstruction Reverses Profound Pseudoparalysis in Patients With Irreparable Rotator Cuff Tears and Minimal or No Glenohumeral Arthritis.

PURPOSE: The purpose of the study was to investigate the rate and magnitude of return of active forward elevation (aFE) of the arm for patients with severe preoperative elevation dysfunction (less than 45° of aFE and termed profound pseudoparalysis) and massive, irreparable (or partially reparable) rotator cuff tears without arthritis treated with arthroscopic superior capsular reconstruction (SCR). METHODS: The period for this retrospective study was October 2014 to October 2016. Inclusion criteria included patients treated arthroscopically for an incompletely reparable massive rotator cuff tear (2 tendons fully torn or tear dimension > 5 cm), preoperative aFE of less than 45° (profound pseudoparalysis) with full passive elevation, an intact or reparable subscapularis tendon, radiographic classification Hamada 0-3, and 12-month clinical follow-up. The primary outcome measure was aFE (degrees) at 1 year postoperative. Secondary outcomes included visual analog scale pain rating (0-10), American Shoulder and Elbow Surgeons score, subjective shoulder value, and active external rotation. Graft integrity and Goutallier grade of supraspinatus and infraspinatus at 1 year postoperative were evaluated by magnetic resonance imaging. RESULTS: Ten patients met the inclusion criteria. Nine of 10 patients (90%) regained active overhead use of the arm after SCR with preoperative aFE (mean ± standard error of the mean [95% confidence interval (CI)]) 27° ± 2° [95% CI, 24°-30°] improving to postoperative aFE 159° ± 15° [95% CI, 130°-187°; P < .0001]. All secondary outcome measures were also improved at 1 year postoperative (visual analog scale, 4.6 ± 0.8 to 0.5 ± 0.2; P = .001; American Shoulder and Elbow Surgeons, 52 ± 6 to 89 ± 3; P = .0002; subjective shoulder value, 36 ± 3 to 91 ± 1; P < .0001; active external rotation, 24° ± 7° to 43° ± 8°; P = .002), and 7 of 10 SCR grafts were fully healed by MRI. No complications or reoperations occurred. CONCLUSIONS: Profound pseudoparalysis of the shoulder (active elevation less than 45°) in massive, irreparable rotator cuff tears without arthritis was reversed in 90% of patients after arthroscopic SCR. Reverse shoulder replacement has been proposed to be the only reliable surgical option in this patient group, but SCR appears to be a valid joint-preserving option for improving function with a low rate of complications. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Rotator Cuff Repair: Single Row Repair Versus Double Row Repair and Superior Capsular Reconstruction.

The surgical management of rotator cuff (RC) tears has progressed considerably in recent decades. Arthroscopic procedures now represent the mainstay of contemporary treatment approaches. The success of repair is predicated upon the achievement of a secure, durable repair that promotes tendon-to-bone healing. Both single and double row (DR) suture anchor configurations have been described to achieve stable fixation. Although consensus is lacking with regard to the clinical superiority of one configuration over another, trends in the literature suggest that DR repairs may optimize the likelihood of tendon healing and restoration of shoulder strength. In cases of truly irreparable RC tears, superior capsular reconstruction is a promising alternative to open tendon transfer and arthroplasty procedures. The purposes of this concise review are to: (1) explain our preference for a DR repair configuration in almost all circumstances; and (2) advocate superior capsular reconstruction as a viable treatment tactic for truly irreparable RC tears in the absence of significant glenohumeral arthritis.

Editorial Commentary: Superior Capsule Reconstruction With Dermal Allograft: Achieving the Goal of Joint Preservation.

Active patients with massive irreparable rotator cuff tears and no glenohumeral arthritis have long posed a dilemma for shoulder surgeons. Such high-demand patients do not do well with partial cuff repair, as their results tend to deteriorate over time. They are also not good candidates for reverse total shoulder arthroplasty due to high rates of complications and high revision rates. The early good results of superior capsular reconstruction for these challenging patients are very encouraging, and they highlight the potential for superior capsular reconstruction to be a reliable joint-preserving option with low morbidity.

Superior Capsule Reconstruction.

In patients who have a massive rotator cuff tear without glenohumeral arthritis in whom surgery is indicated, surgeons should always attempt a complete repair. Interval slides and linked high-strength repair constructs can be used; however, despite advanced mobilization and repair techniques, some rotator cuff tears are not fully repairable. Promising early outcomes have been reported in select patients with a massive rotator cuff tear who undergo superior capsule reconstruction with the use of acellular dermal allograft.

Preoperative Radiographic Risk Factors for Incomplete Arthroscopic Supraspinatus Tendon Repair in Massive Rotator Cuff Tears.

PURPOSE: To determine if preoperative imaging findings of massive rotator cuff (RC) tears were associated with (1) incomplete arthroscopic repair and (2) the use of advanced mobilization techniques (interval slides) and/or the use of a load-sharing rip stop repair construct. METHODS: Eighty-six consecutive patients who underwent arthroscopic repair for massive RC tears performed by a single surgeon between July 2013 and July 2015 were retrospectively evaluated. Previously proposed radiographic risk factors for irreparability (acromiohumeral distances, tangent sign, and the Goutallier stage of fatty infiltration for the supraspinatus) were analyzed. Associations between preoperative imaging characteristics and intraoperative results of RC surgery were determined using binary logistic regressions and Fisher's exact tests. The interobserver reliability of imaging characteristics was determined using intraclass correlation coefficients (ICCs). RESULTS: Seventy-six massive RC tears were fully reparable (88%). In the case of 10 RC tears (12%), a complete repair was not obtained. Inability to obtain a complete repair of the supraspinatus was associated with a positive tangent sign (30% irreparable) versus a negative tangent sign (6.3% irreparable, odds ratio [OR] = 6.3, P = .0102) and with Goutallier grade 3-4 fatty infiltration of the supraspinatus (42.9% irreparable) versus grade 0-2 fatty infiltration (5.7% irreparable, OR = 11.8, P = .001). Advanced arthroscopic techniques (interval slides or load-sharing rip stop) for dealing with poor-quality or retracted tendon were used in 62% of cases; however, no associations were found between preoperative imaging characteristics and these techniques. Interobserver reliability was moderate (ICC = 0.75-0.90) for the tangent sign (ICC = 0.78) and high-grade (Goutallier 3-4) fatty infiltration of the supraspinatus (ICC = 0.74). CONCLUSIONS: A positive tangent sign and/or high-grade fatty infiltration (Goutallier 3-4) of the supraspinatus were risk factors for incomplete RC repair. However, these were not completely predictive of reparability because the majority of massive RC tears with these imaging characteristics were still fully reparable. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft.

PURPOSE: The purpose of this study was to evaluate the short-term outcomes of arthroscopic superior capsule reconstruction (SCR) with dermal allograft for the treatment of irreparable massive rotator cuff tears (MRCTs). METHODS: A multicenter study was performed on patients undergoing arthroscopic SCR for irreparable MRCTs. The minimum follow-up was 1 year. Range of motion and functional outcome according to visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV) score were assessed preoperatively and at final follow-up. Radiographs were used to evaluate the acromiohumeral interval (AHI). RESULTS: Fifty-nine patients with a mean age of 62.0 years had a minimum follow-up of 1 year. Twenty-five patients (42.4%) had a prior rotator cuff repair. Forward flexion improved from 130° preoperative to 158° postoperative, and external rotation improved from 36° to 45°, respectively (P < .001). Compared with preoperative values, the VAS decreased from 5.8 to 1.7, the ASES score improved from 43.6 to 77.5, and the SSV score improved from 35.0 to 76.3 (P < .001). The AHI was 6.6 mm at baseline and improved to 7.6 mm at 2 weeks postoperatively but decreased to 6.7 mm at final follow-up. Based on postoperative magnetic resonance imaging, 45% (9 of 20) of the grafts demonstrated complete healing. Forty-six (74.6%) cases were considered a success. Eleven patients (18.6%) underwent a revision procedure including 7 reverse shoulder arthroplasties. CONCLUSIONS: Arthroscopic SCR using dermal allograft provides a successful outcome in approximately 70% of cases in an initial experience. The preliminary results are encouraging in this difficult to manage patient population, but precise indications are important and graft healing is low in our initial experience. LEVEL OF EVIDENCE: Level IV, case series.