Patch Augmentation Using Acellular Dermal Matrix During Arthroscopic Rotator Cuff Repair Reduces Retear Rates in High‐Risk Patients With Rotator Cuff Healing Index 7 or Higher

PURPOSE: To compare retear rates and short-term clinical outcomes between arthroscopic rotator cuff repair (ARCR) and ARCR with patch augmentation (PA) using acellular dermal matrix allograft according to the Rotator Cuff Healing Index (RoHI), in order to identify appropriate indications for PA. METHODS: This retrospective study included patients aged 50 years or older who underwent primary ARCR between 2017 and 2023, with a minimum follow-up of 12 months. Patients were stratified according to the RoHI score and categorized into ARCR alone (ARCR) and ARCR with PA groups. The receiver operating characteristic curve analysis was performed to assess the predictive performance of the RoHI for retears in the ARCR group. Cumulative retear rates and clinical outcomes, including active range of motion, American Shoulder and Elbow Surgeons, and Constant score were compared between groups across RoHI score thresholds. RESULTS: A total of 738 patients were included (ARCR group, n = 659; PA group, n = 79). In the ARCR group, the RoHI showed fair predictive performance (area under the curve, 0.774; 95% confidence interval, 0.719-0.828), with an optimal cutoff score of 7. Among patients with RoHI score ≥7, cumulative retear rate was significantly lower in the PA group than in the ARCR group (21.6% vs 36.6%, P = .048), and this difference remained significant among female patients (8.3% vs 28.3%, P = .015). However, there were no significant differences in range of motion and clinical outcomes (PA vs ARCR; 72.7 ± 10.7 vs 70.4 ± 13.3 for American Shoulder and Elbow Surgeons score; 59.6 ± 10.9 vs 61.7 ± 10.8 for Constant score) between groups at a mean follow-up of 18.9 ± 5.6 (range, 12-24) months. The proportion of patients achieving the minimal clinically important difference for American Shoulder and Elbow Surgeons (PA vs ARCR; 72.1% vs 57.9%) and Constant score (39.5% vs 49.6%) was also comparable between the groups. CONCLUSIONS: A marked increase in the retear rate was observed from a RoHI score of 7 or higher, and in these high-risk patients, patch augmentation using acellular dermal matrix allograft effectively reduced the retear rate regardless of sex, although short-term clinical outcomes were comparable to those of ARCR alone. LEVEL OF EVIDENCE: Level III, retrospective case-control study.