A Retrospective Evaluation of Biologic Tuberoplasty with Medialization Technique for Massive Rotator Cuff Tears Using Acellular Dermal Matrix

Background: Massive Irreparable Rotator Cuff Tears (MIRCTs) remain one of the most challenging conditions in shoulder surgery. While partial repair with medialization may reduce tension and biologic tuberoplasty with Acellular Dermal Matrix (ADM) can restore the tuberosity coverage, each technique alone has limitations. Combining the two may yield complementary benefits. Purpose: To evaluate the clinical and radiologic outcomes of arthroscopic medialized partial repair combined with biologic interpositional tuberoplasty using ADM in patients with MIRCTs. Methods: A retrospective review was conducted on 36 patients who underwent the combined procedure between 2021 and 2023, with a minimum 12-month follow-up. Clinical outcomes including the Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, UCLA score, Constant score and Range Of Motion (ROM) were assessed. Radiologic assessments included Acromiohumeral Distance (AHD), retear status (Sugaya classification) and graft failure. Paired t-tests were used to evaluate pre- and postoperative differences. Results: All clinical scores showed significant improvements postoperatively: VAS (6.2 ± 1.6 to 1.5 ± 1.3, p < 0.001), ASES (35.0 ± 15.3 to 85.5 ± 14.8, p < 0.001), UCLA (21.4 ± 3.8 to 31.5 ± 2.8, p < 0.001), Constant (43.8 ± 7.2 to 86.0 ± 8.2, p < 0.001). Forward flexion, abduction and both external and internal rotation significantly improved. AHD was maintained (6.2 ± 1.5 mm to 6.4 ± 1.4 mm, p = 0.138). The retear rate based on Sugaya grade 4 or 5 was 11.1% and no graft failures were reported. Conclusion: The combination of medialization repair and biologic tuberoplasty for MIRCTs is a viable surgical option, offering significant improvement in pain, function and ROM, while maintaining graft integrity and minimizing retear risk. This approach effectively complements the limitations of each individual technique.