Arthroscopic Superior Capsular Reconstruction With Mesh Augmentation for the Treatment of Irreparable Rotator Cuff Tears: A Comparative Study of Surgical Outcomes

Abstract

Background: Arthroscopic superior capsular reconstruction (ASCR) is an alternative to open surgery for irreparable chronic rotator cuff tears (RCTs). This approach can provide static restraint while avoiding upward migration of the humeral head. However, graft tears and their effect on clinical outcomes after ASCR remain a debated topic. Purpose: To evaluate the clinical outcomes of ASCR with mesh augmentation for the treatment of irreparable RCTs. Study Design: Cohort study; Level of evidence, 3. Methods: The data of 72 patients with irreparable RCTs who underwent ASCR between 2013 and 2018 were retrospectively evaluated. Among them, 64 patients who met the inclusion and exclusion criteria were enrolled in this study. Fascia lata grafts augmented with a polypropylene mesh were used for 30 patients (mesh group), and grafts without mesh augmentation were used for 34 patients (control group). Clinical outcomes were evaluated using range of motion, the American Shoulder and Elbow Surgeons (ASES) questionnaire, and visual analog scale for pain. Radiological outcomes were evaluated according to acromiohumeral distance and stage of rotator cuff arthropathy. The status of fatty infiltration and graft integrity was evaluated using magnetic resonance imaging. Outcomes were assessed preoperatively and at the final follow-up. Results: Both groups showed improvement in clinical and radiological outcomes at the final follow-up. The mesh group demonstrated a larger improvement in ASES score (mean ± SD, 29.1 ± 15.8) than the control group (18.1 ± 15.9) ( P = .006). The mean improvement in active forward flexion was significantly higher in mesh group (40°± 26°) than in control group (28°± 23°) ( P = .003). The mean improvement in active external rotation was also significantly higher in the mesh group (11°± 5°) than in the control group (6°± 3°) ( P = .004). Graft healing rate was significantly higher in the mesh group (83.3%) than in the control group (58.8%) ( P = .039), and acromiohumeral distance was significantly greater in the mesh group (9.1 ± 2.4 mm) than in the control group (6.3 ± 1.8 mm) at the final follow-up ( P = .001). Subgroup analysis revealed that patients with graft failure generally showed progression of fatty infiltration without improvement in the stage of rotator cuff arthropathy. Patients with intact grafts demonstrated a more substantial improvement in functional outcomes (ASES score and forward flexion motion). Conclusion: ASCR with mesh augmentation reduced graft failure rate to restore superior shoulder joint stability.

Arthroscopic Superior Capsular Reconstruction for Older Patients With Irreparable Rotator Cuff Tears: A Comparative Study With Younger Patients

“…(1) Severe bone deformity (Hamada grade 5) (2) Severe superior migration of the humeral head that could not be corrected using manual arm traction during diagnostic arthroscopy (3) Irreparable subscapularis tendon (4) Cervical nerve and axillary nerve palsy (5) Previous rotator cuff surgery (6) Revision of the ASCR (7) \2 years of minimum follow-up (8) Patient died of an unrelated cause ASCR was performed between January 2013 and September 2016, and ASCR using mesh augmentation was performed between October 2016 and June 2020. 24 The modification of the surgical technique was made arbitrarily by the operating surgeon based on the observation of the preliminary result. 24 ASCR was performed for patients in relatively good general condition based on the American Society of Anesthesiologists physical status classification (grade, \3) disregarding chronologic age.…”

“…24 The modification of the surgical technique was made arbitrarily by the operating surgeon based on the observation of the preliminary result. 24 ASCR was performed for patients in relatively good general condition based on the American Society of Anesthesiologists physical status classification (grade, \3) disregarding chronologic age. 10,29 A total of 73 patients were included in the present study for analysis.…”

Failure Rate After Superior Capsular Reconstruction With Achilles Tendon–Bone Allograft for Irreparable Rotator Cuff Tears

“…3 The timing of graft tear was categorized as early (within 3 months postoperatively), midterm (at 3-6 months postoperatively), and late (after 6 months postoperatively). 24 The acromiohumeral distance (AHD) was measured using plain standard shoulder radiographs, which were taken with the radiographic beam tilted 20° caudally in anteroposterior projection. 58 The stage of rotator cuff arthropathy was evaluated using the Hamada classification system.…”

SCR 2021

“…In recent years, other surgical groups have also reported the results of autograft SCR, often with their own modifications. 2,3,12,16 Azevedo et al, 2 for example, utilized a fascia lata autograft harvested with a minimally invasive technique. Kholinne et al 12 reported that reinforcing a fascia lata autograft SCR with polypropylene mesh yielded improved results in graft integrity and several clinical parameters.…”

“…2,3,12,16 Azevedo et al, 2 for example, utilized a fascia lata autograft harvested with a minimally invasive technique. Kholinne et al 12 reported that reinforcing a fascia lata autograft SCR with polypropylene mesh yielded improved results in graft integrity and several clinical parameters. Barth and colleagues 3 have described their experience utilizing the native long head biceps tendon in lieu of fascia lata for massive posterosuperior rotator cuff tears.…”