Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft

Abstract

Despite the growing interest on delaminated rotator cuff tear, the optimal surgical method is still controversial. In this prospective study, the result of two different surgical methods; en masse repair and separate double layer double row repair were compared. Both treatments were effective in improving clinical outcomes. Lower pain scores were seen in separate double-layer double-row repair. ABSTRACT DATA Introduction: Recently, there has been a growing interest on the delaminated tear of full thickness rotator cuff tear. For the treatment of delaminated rotator cuff tear, conventional suture bridge (transosseous equivalent) repair, described as en masse repair and separate double layer double row repair have been performed. The aim of this study was to determine the optimal surgical method for the treatment of delaminated rotator cuff tear. For this purpose, we compared clinical results between conventional en masse repair and separate double-layer repair for the treatment of delaminated rotator cuff tear. Methods: Between August 2007 and March 2014, a total of 82 patients who underwent arthroscopic rotator cuff repair of a delaminated tear were enrolled and randomized into 2 groups. In group 1 (n ¼ 48), arthroscopic conventional en masse repair was performed. In group 2 (n ¼ 34), separate double-layer double-row repair was performed. Articular layer was repaired in knotless manner. The American Shoulder and Elbow Surgeons score, Constant score, Simple Shoulder Test score, and visual analog scale (VAS) score for pain and range of motion (ROM) were assessed before surgery; at 3, 6, and 12 months after surgery; and at the last follow-up visit. Magnetic resonance imaging (MRI) was performed at 12 months postoperatively to examine the retear rate and pattern. Results: There was no significant difference between groups in the preoperative demographic data, including patient age, sex, symptom duration, tear size, and functional scores (P > .05). The mean follow-up period was 25.9 months. The group 2 had significantly lower VAS pain scores (P<.05) at postoperative 3, 6, and 12 months. The functional scores and ROM showed no significant difference between the groups at each time point. Eight of 48 patients in group 1 and six of 34 patients in group 2 showed re-tears on MRI at 12 month follow up, but the difference was not significant statistically(P > .05). Conclusion: Both conventional en masse repair and separate double-layer double-row repair were effective in improving clinical outcomes in the treatment of delaminated rotator cuff tears. However, lower pain scores were seen in patients who underwent separate double-layer double-row repair.

Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear

“…Further, SCR may be a rational treatment option for relatively young patients with joint-conserving surgery and non-recoverable RCT. In contrast, it is a technically difficult procedure that requires extension of operation time and the risk of associated complications, such as infection, often increases; moreover, the materials needed and the effects of using SCR are not yet established [21]. Satisfactory results have been reported in SCR which surpasses other treatment outcomes and is becoming popular, and few studies have reported on the postoperative results and indications.…”

Editorial Commentary: SCR: Substantial Confusion Remains

“…Lee and Min 10 state in their clinical study that graft thickness, not the graft type, reduced superior translation. Denard et al 14 reported an overall success rate of 70%, but only 40% success when using a 1-mm graft. When choosing a graft, they report the advantages of a commercially available 3-mm dermal allograft and reductions in both operative time and autologous graft harvest morbidity.…”

Editorial Commentary: Off the Hip or Off the Shelf? An Analysis of Autograft and Allograft as a Graft Source for Shoulder Superior Capsular Reconstruction

“…His ingenious solution was the SCR, which was a minimally invasive, joint-preserving option that the rest of the world would soon adopt as a legitimate alternative to the RSA and tendon transfers. [3][4][5][6][7][8] To further complicate the issue, stringent regulation and lack of tissue banks limit the availability of allograft tissue in Japan. To meet this challenge, Mihata used fascia lata autograft to reconstruct the superior capsule.…”