Lack of Evidence for Improved Outcomes With Dermal Allograft Augmentation of Revision Arthroscopic Rotator Cuff Repair: A Systematic Review
Eoghan T. Hurley, Juan Bernardo Villarreal‐Espinosa, Jay M. Levin, Oke A. Anakwenze, Christopher S. Klifto, Surena NamdariPurpose
To perform a systematic review to evaluate the available literature and effect of dermal allograft augmentation for revision arthroscopic rotator cuff repair (ARCR) on patient‐reported outcomes, range of motion, and structural healing.
Methods
A systematic literature search was conducted based on the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. PubMed, Embase, and Cochrane Library databases were queried from database inception to August 2025 for clinical studies evaluating revision rotator cuff repair with and without dermal allograft augmentation. Extracted outcomes included patient‐reported outcome measures, range of motion, retear rates, complications, and reoperations. Data is presented in a qualitative manner because of the heterogeneity and predominance of lower‐level evidence literature.
Results
A total of 27 studies (8 Level of evidence III; 19 Level of evidence IV, n = 28 cohorts, 1244 shoulders) evaluated the isolated revision ARCR, with 6 cohorts (136 shoulders) assessing augmented revision repairs using dermal allograft. American Shoulder and Elbow Surgeons scores in the isolated revision cohort ranged from 66 to 86.8, whereas augmented repairs showed similar scores (77‐86). Constant and Single Assessment Numeric Evaluation scores were similar between the groups. Postoperative forward flexion ranged from 100° to 158° in the isolated revision ARCR and reached 160° in 1 augmented study. Retear rates in the isolated revision ARCR varied widely (range: 0%‐70%), with complication and reoperation rates ranging from 0% to 7.2% and 0% to 15.6%, respectively. Similarly, augmented repairs had a mean retear rate range of 17% to 57%, with complication data reported in only 1 study (n = 13), and reoperation rates ranging from 0% to 23%.
Conclusions
Revision ARCR is associated with postoperative improvements in patient‐reported and functional outcomes; however, there is insufficient evidence to recommend routine dermal allograft augmentation at this time.
Level of Evidence
Level IV, systematic review of Level III and IV studies.