Classification system of graft tears following superior capsule reconstruction

Mirzayan, Raffy; Acevedo, Daniel Camilo Aguirre; Sidell, Margo; Otarodifard, Karimdad; Hall, Michael; Suh, Brian H.; Singh, Anshuman

doi:10.1016/j.clinimag.2021.11.035

Cited by 6 publications

(3 citation statements)

References 41 publications

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“…Moreover, graft tears have been reported [ 17 , 18 ]. Mirzayan et al [ 7 ] have classified graft tear patterns into three categories: 1. Intact graft 2.…”

Section: Discussionmentioning

confidence: 99%

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Preliminary Outcomes of Arthroscopic Biologic Tuberoplasty in the Treatment of Massive Irreparable Rotator Cuff Tears

Mirzayan¹

2023

Cureus

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Introduction: Several treatment options exist for the treatment of massive, irreparable rotator cuff tears. A novel technique has been described whereby an acellular dermal allograft is secured to the greater tuberosity which acts as an interpositional tissue preventing bone-to-bone contact between the greater tuberosity and acromion. The preliminary results of this arthroscopic procedure are being presented. Methods: Patients who underwent a biologic tuberoplasty procedure between 2015 and 2022, by a single surgeon, were included in this study. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and visual analogue pain scores (VAS) were prospectively recorded and retrospectively reviewed. Postoperative MRI was obtained in some cases. Paired t-test was used to calculate significance set at <0.05. Results: Ten patients met the inclusion criteria. The mean age was 70.4+4.7 years (range 65-78). There were five males. The mean length of follow-up was 21+27 months (range six to 95 months). There was significant improvement in ASES (24.3+4 to 91.5+10.3, P<0.00001), SANE (22.5+10.3 to 88+11.6, P<0.00001), and VAS (8.8+0.6 to 1.1+2.5, P<0.00001). MRI was obtained in seven patients at a mean of 5.3+2.9 months and showed a healed graft to the tuberosity in all cases. Conclusion: Biologic tuberoplasty is an effective procedure in improving pain and functional outcomes in patients with massive, irreparable rotator cuff tears.

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“…Moreover, graft tears have been reported [ 17 , 18 ]. Mirzayan et al [ 7 ] have classified graft tear patterns into three categories: 1. Intact graft 2.…”

Section: Discussionmentioning

confidence: 99%

“…Although the overall outcomes of SCR have been positive, graft tears have been reported [ 6 ]. Mirzayan et al [ 7 ] classified graft tear patterns following SCR with dermal allograft into three types: 1. Intact graft, 2.…”

Section: Introductionmentioning

confidence: 99%

Preliminary Outcomes of Arthroscopic Biologic Tuberoplasty in the Treatment of Massive Irreparable Rotator Cuff Tears

Mirzayan¹

2023

Cureus

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“…A previous study on graft classifications was conducted on patients in whom SCR was performed using alloderm. 30 In that report, the authors also used 5 categories to stratify the graft condition according to the presence and location of the tear as follows: intact, tear from the glenoid, midsubstance tear, tear from the tuberosity, and absent graft. However, there was no further description of the graft state in that study, which limited its capacity to explain and understand the changes that occurred due to autograft remodeling.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a New MRI-Based Classification of Graft Status After Superior Capsule Reconstruction

Lee,

Kholinne,

Yeom

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: A classification system for the graft state after superior capsule reconstruction (SCR) using magnetic resonance imaging (MRI) has not been described previously. Purpose: To introduce a new, MRI-based classification system for graft integrity after SCR and to evaluate the system according to postoperative outcomes. Study Design: Cohort study (diagnosis); Level of evidence, 3. Method: Included were 62 consecutive patients who underwent SCR using autologous fascia lata graft between January 2013 and April 2021. Postoperative outcomes were assessed (American Shoulder and Elbow Surgeons [ASES] score, Constant score, pain visual analog scale [pVAS], range of motion [ROM], acromiohumeral distance [AHD], Hamada grade). Graft status was classified by 2 orthopaedic surgeons on postoperative MRI in accordance with the signal intensity and the presence or extent of the tear, as follows: type 1 (hypointense signal without tear), type 2 (hyperintense signal without tear), type 3 (partial-thickness tear), type 4 (full-thickness tear with partial continuity), and type 5 (full-thickness tear with complete discontinuity). Intra- and interobserver agreement were assessed using Cohen kappa. The correlation between postoperative outcomes (ASES score, Constant score, pVAS, ROM, AHD, and Hamada grade) and the SCR graft classification system was assessed with the Pearson correlation coefficient, and the outcomes were compared according to classification type. Results: Patients were classified according to the new system as follows: type 1 (n = 15), type 2 (n = 20), type 3 (n = 7), type 4 (n = 8), and type 5 (n = 12). There was excellent interobserver agreement (κ = 0.819) and intraobserver agreement (κ = 0.937 and 0.919). The classification system showed a moderate to high correlation with the ASES score ( r = –0.451; P = .001), pVAS ( r = 0.359; P = .005), AHD ( r = –0.642; P < .001), and Hamada grade ( r = 0.414; P < .001). Patients classified as having types 1 and 2 showed better outcomes in terms of ASES score, pVAS, ROM, and AHD compared with type 5 patients ( P ≤ .021 for all). Conclusion: The new classification system was highly reproducible and showed clinical utility for both radiological and clinical evaluation after SCR.

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Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed

Lubowitz¹,

Brand²,

Rossi³

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Classification system of graft tears following superior capsule reconstruction

Cited by 6 publications

References 41 publications

Preliminary Outcomes of Arthroscopic Biologic Tuberoplasty in the Treatment of Massive Irreparable Rotator Cuff Tears

Preliminary Outcomes of Arthroscopic Biologic Tuberoplasty in the Treatment of Massive Irreparable Rotator Cuff Tears

Evaluation of a New MRI-Based Classification of Graft Status After Superior Capsule Reconstruction

Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed

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