Clinical Outcomes of Superior Capsular Reconstruction for Massive, Irreparable Rotator Cuff Tears: A Systematic Review Comparing Acellular Dermal Allograft and Autograft Fascia Lata

Abstract

Purpose To investigate clinical outcomes after superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears treated with either allograft or autograft. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, in April 2020 a systematic review was performed using PubMed, MEDLINE, EMBASE, and Cochrane databases. Clinical studies were assessed for patient-reported outcomes and range of motion, comparing dermal allografts to fascia lata autografts, with a minimum follow-up of 12 months. Results A total of 16 clinical studies involving 598 patients (606 shoulders) were included for data analysis, with a weighted mean follow-up of 36.9 months (range 12 to 60). Visual analogue scale (VAS) pain scores decreased from 4.0 to 6.9 mm preoperatively to 0 to 2.5 mm postoperatively. American Shoulder & Elbow Surgeons score increased from 20.3 to 54.5 preoperatively to 73.7 to 97.0 postoperatively. Forward flexion increased from 27.0° to 142.7° preoperatively to 134.5° to 167.0° postoperatively. External rotation increased from 13.2° to 41.0° preoperatively to 30.0° to 59.0° postoperatively. Acromiohumeral distance increased from 3.4 to 7.1 mm preoperatively to 6.0 to 9.7 mm postoperatively. The total rates of complications, graft failure, and revision surgery were 5.6%, 13.9%, and 6.9%, respectively. Conclusions Irrespective of tissue source, SCR serves as a reasonable joint-preserving option for massive, irreparable rotator cuff tears, with favorable short- to midterm improvements in patient-reported outcomes and range of motion. Level of Evidence IV, systematic review of level III and IV studies.

Donor-Site Morbidity After Autologous Fascia Lata Harvest for Arthroscopic Superior Capsular Reconstruction: A Midterm Follow-up Evaluation

“… 26 Systematic reviews could not compare clinical outcomes between different types of grafts and highlighted the heterogeneity among the studies. 9 , 22 , 30 , 42 , 45 , 51 …”

“…26 Systematic reviews could not compare clinical outcomes between different types of grafts and highlighted the heterogeneity among the studies. 9,22,30,42,45,51 The good results of ASCR that uses AFL come with a price: the additional harvesting procedure and the resultant residual symptoms. According to the current study, 95% of the patients considered the price to be fair and would be willing to undergo the procedure again.…”

Arthroscopic Superior Capsular Reconstruction with Achilles Tendon Allograft for Massive and Revision Rotator Cuff Tears

“…On the other hand, use of fascia lata autograft comes with increased risks of donor site morbidity and increased operation time. Dermal allografts are also popular 10,11,12 in SCR; however, they result in a thinner graft (3-4 mm) and they costs more.…”

The clinical outcomes of infraspinatus rotational transfer for irreparable posterosuperior rotator cuff tears: a preliminary report

“…SCR has been increasingly investigated and reported in recent years. In a systematic review, graft tears in the dermal allograft and the autograft fascia lata were reported to be 13.9% overall [25]. A wide range of failure rates has been reported, depending on the type of graft: 5%-32% for the fascia lata autograft and 20%-70% for the human dermal allograft.…”