Clinical and Functional Outcomes by Graft Type in Superior Capsular Reconstruction: A Systematic Review and Meta-analysis

Abstract

Background: In recent years, superior capsular reconstruction (SCR) has emerged as a promising treatment for massive rotator cuff tears and has been performed with an array of graft options, most commonly dermal allograft and tensor fascia lata (TFL) autograft. Purpose: To compare the clinical outcomes, functional outcomes, and complication rates after SCR performed with dermal allograft, TFL autograft, long head of the biceps tendon (LHBT) autograft, and porcine xenograft. Study Design: Meta-analysis; Level of evidence, 4. Methods: PubMed, Cochrane Library, and Embase were systematically reviewed for studies that enrolled ≥10 patients who underwent SCR and presented clinical outcome data at a minimum follow-up of 12 months. When available, pre- and postoperative patient-reported outcome scores and clinical examination data were extracted. Outcome data were then compared by graft type. A meta-analysis was also conducted of graft tear and reoperation rates after SCR with dermal allograft and TFL autograft. Results: Human dermal allograft and TFL autograft were each utilized in 7 studies, LHBT autograft in 2 studies, and porcine xenograft in 1 study. Dermal allograft, TFL autograft, and LHBT autograft demonstrated comparable median (range) postoperative American Shoulder and Elbow Surgeons scores of 85.3 (77.5-89), 88.6 (73.7-94.3), and 82.7 (80-85.4), respectively. The median postoperative pain scores per visual analog scale for dermal allograft, TFL autograft, and LHBT autograft were 0.8, 2.5, and 1.4. Median postoperative forward elevation was 159.0°, 147.0°, 163.8°, and 151.4° for dermal allograft, TFL autograft, LHBT autograft, and porcine xenograft. Meta-analysis demonstrated a comparable pooled graft tear rate between TFL autograft (9%; 95% CI, 4%-16%) and dermal allograft (7%; 95% CI, 2%-13%). Similarly, the pooled reoperation rate was similar for TFL autograft (3%; 95% CI, 0%-7%) and dermal allograft (6%; 95% CI, 2%-12%). Among the 3 studies with pre- and postoperative information on pseudoparalysis, 73 of 76 (96%) patients with an intact/repairable subscapularis had a reversal of their pseudoparalysis after SCR. Conclusion: Dermal allograft, TFL autograft, and LHBT autograft are all suitable options for SCR and demonstrate significant improvements in American Shoulder and Elbow Surgeons score, pain score per visual analog scale, and forward elevation. Moreover, dermal allograft and TFL autograft have comparable rates of graft tear and reoperation.

Welche Faktoren sind mit einer Reruptur nach superiorer Kapselrekonstruktion der Schulter mit autologer langer Bizepssehne assoziiert? – Ein systematischer Review

“…This systematic review provides evidence that preoperative identifiable factors exist with reduced healing after superior capsulo-plasty with autologous long biceps tendon in reconstruction of the rotator cuff of the shoulder [6,7,14]. Two published systematic reviews identified elsewhere generally address the clinical outcomes of superior capsuloplasty with autologous long biceps tendon [10] and the comparison between different grafts for superior capsuloplasty, respectively, [11] without focusing on the abovementioned factors. Although future, more specific studies with longer follow-up periods need to further demonstrate that such factors are relevant, it is already clear that superior capsuloplasty with autologous long biceps tendon can play a cost-effective jointpreserving role in difficult cases [21].…”

“…Registration of this systematic review in the PROSPERO database was not requested. PubMed identified two systematic reviews that generally addressed the clinical outcomes of superior capsuloplasty with autologous long biceps tendon [10,11]. This systematic review was conducted without financial support.…”

“…Moreover, this paper focused on the radiological results; the clinical results, which are no less important, were not in the foreground here. However, two other systematic reviews with a different focus have already identified good clinical results [10,11].…”

Arthroscopic Superior Capsular Reconstruction

“…5 Multiple series evaluating the outcomes of superior capsule reconstruction have been published. 1,3,4 With the use of SCR dermal allograft, preoperative measures improved at a minimum of 1 year for active forward flexion, visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), and Subjective Shoulder Value (SSV) scores. The authors determined that 75% of cases were considered a success.…”

Biomechanical outcomes of superior capsular reconstruction for irreparable rotator cuff tears by different graft materials-a systematic review and meta-analysis

“…The graft's biomechanical function was as a static stabilizer that diminishes the pressure at the subacromial contact pressure and prevents superior translation of the humeral head ( 16 , 17 ). As a new arthroscopic technique, the selection of graft materials was disputed ( 18 – 20 ). SCR with fascia lata(FL) showed a significant reduction in pain and functional improvements, such as range of motion, and rates of return to work and sports ( 21 – 23 ).…”