Superior capsule reconstruction using dermal allograft: early outcomes and survival

Woodmass, Jarret M.; Wagner, Eric R.; Borque, Kyle A.; Chang, Michelle J.; Welp, Kathryn M.; Warner, Jon J.P.

doi:10.1016/j.jse.2019.04.011

Cited by 68 publications

(88 citation statements)

References 46 publications

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“…2,20,40,48,52 This is the first study to date to report the reliability statistics for the MRI outcomes of graft integrity, fatty infiltration, and atrophy of the rotator cuff muscles after ASCR. 11,12,28,29,36,37,41,50 The proportion of complete graft tears was 21.1% at 3 years, which was the most reliable MRI outcome of the present study, whereas the proportion of partial tears was less reliable and ranged from 10.5% to 21.1% across the 3 raters. The low agreement with regard to the location of partial tears of the graft further highlights the difficulty in the interpretation of MRI scans taken after ASCR.…”

Section: Discussionmentioning

confidence: 47%

“…The length of the follow-up period was a consequence of a combination of factors, including the novelty of ASCR, the prospective design, and the MRI assessment. Indeed, the other studies that have reported graft integrity after ASCR using MRI are mostly retrospectively designed and have a minimum follow-up period of 6 to 12 months 11,12,28,29,41,50 or 2 to 5 years. 36,37 The 3-year time point for the assessment of graft integrity using MRI was considered important to fill the gap in knowledge on the outcomes of patients with a midthigh FLA beyond 6 months postoperatively.…”

Section: Limitationsmentioning

confidence: 99%

“…The preliminary clinical studies on ASCR using an HDA or LHBT autograft 6,12,41 did not reproduce the outcomes reported in the studies by Mihata et al 34,37 Survivorship of the graft was one of the differences in the reported outcomes. Clinical studies on ASCR using an HDA have reported a higher proportion of graft tears, ranging from 20% to 75% in the short term (minimum of 6-month to 2-year follow-up), 10,12,14,24,28,41,50 whereas studies using an FLA have reported proportions of graft tears ranging from 4.2% to 32% in the short to medium term (minimum of 6-month to 5-year follow-up). 10,11,28,29,34,36,37 It remains unclear and controversial whether the type of graft or type of graft construct used in ASCR is an important (or even the most important) factor in the clinical success of ASCR.…”

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confidence: 99%

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Clinical Importance of Graft Integrity in Arthroscopic Superior Capsular Reconstruction Using a Minimally Invasively Harvested Midthigh Fascia Lata Autograft: 3-Year Clinical and Magnetic Resonance Imaging Outcomes

et al. 2020

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Background: The clinical importance of graft type and integrity in arthroscopic superior capsular reconstruction (ASCR) remains controversial. Purpose: To assess 3-year clinical and magnetic resonance imaging (MRI) outcomes of ASCR using a minimally invasively harvested fascia lata autograft (FLA) for irreparable rotator cuff tears (IRCTs) and to determine the clinical importance of graft integrity and whether the results change from year 2 to 3. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 consecutive patients who underwent ASCR with a minimally invasively harvested FLA were enrolled in a prospective single-arm study. At 3 years, the patients answered a satisfaction questionnaire and underwent a clinical examination and MRI. The MRI scans were independently reviewed by 3 raters to determine the graft integrity, acromiohumeral interval, supraspinatus atrophy, and fatty degeneration of the rotator cuff muscles. Reliability statistics were calculated, and the outcomes were compared across subgroups of patients with and without complete graft tears. Results: Overall, 21 patients (95.5%) answered the questionnaire, 20/21 (95.2%) were satisfied, 4/20 (20.0%) reported donor site pain, and 19 patients (86.4%) underwent examinations. From preoperatively to 3 years, the mean improvement was 73.68° in elevation (95% CI, 47.59°-99.77°), 89.21° in abduction (95% CI, 66.56°-111.86°), 24.74° in external rotation (95% CI, 4.72°-34.75°), 3.00 in internal rotation (95% CI, 2.36-3.64), 2.61 kg in abduction strength (95% CI, 1.76-3.45 kg), 50.79 on the Constant score (CS; 95% CI, 41.99-59.58), 7.47 on the Simple Shoulder Test (SST; 95% CI, 5.19-9.75), and 36.05% on the subjective shoulder value (SSV; 95% CI, 23.19%-48.92%), which were all significant ( P < .05). From 2 to 3 years, the mean improvement in abduction was 20.26° (95% CI, 5.44°-35.09°), which was significant ( P = .010). At 3 years, the raters perfectly agreed (kappa = 1; P = .000013) that 4 patients (21.1%) had complete graft tears; this subgroup of patients had decreased external rotation strength at 90° of abduction (1.77 ± 0.17 vs 4.45 ± 2.55 kg, respectively; P = .027) and increased grades of infraspinatus (3.50 ± 0.58 vs 2.20 ± 1.01, respectively; P = .030) and teres minor fatty degeneration (3.25 ± 0.96 vs 1.53 ± 0.64, respectively; P = .005) compared with those without a complete graft tear, but the mean CS, SST, and SSV scores did not differ from those of the overall group (69.50 ± 5.20 vs 69.63 ± 18.25; 9.00 ± 2.31 vs 9.74 ± 4.73; and 72.50 ± 15.00 vs 71.58 ± 26.70, respectively). Conclusion: The 3-year clinical outcomes of ASCR using a minimally invasively harvested FLA for IRCTs were good, despite donor site morbidity. Active abduction improved significantly from 2 to 3 years. Complete graft tears were correlated with significantly decreased external rotation strength at 90° of shoulder abduction and increased grades of infraspinatus and teres minor fatty degeneration. Registration: NCT03663036 (ClinicalTrials.gov identifier)

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Section: Discussionmentioning

confidence: 47%

Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Importance of Graft Integrity in Arthroscopic Superior Capsular Reconstruction Using a Minimally Invasively Harvested Midthigh Fascia Lata Autograft: 3-Year Clinical and Magnetic Resonance Imaging Outcomes

et al. 2020

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“…Favorable outcomes have been reported, including significant improvements in pain and range of motion in the shoulder. Further techniques have evolved to obviate the need for fascia lata autograft use and reduce graft site morbidity 11 . However, high re‐tear rates at the glenoid side have been frequently reported during medium‐term follow‐up 12 .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic Superior Capsule Reconstruction and Rotator Cuff Repair to Restore Static and Dynamic Stability of the Shoulder

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Hou

Tang

et al. 2020

Orthopaedic Surgery

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Objective: Treatment of massive irreparable rotator cuff tears (RCT) has shown limited clinical success and a variety of subsequent complications. Superior capsule reconstruction (SCR) has been proved to reestablish superior stability but does not restore the dynamic force or shoulder kinematics. There are numerous reports of the short-term failure of SCR grafts at the glenoid side, which relate to the non-biological healing of grafts. To restore both dynamic and static stability and to provide biologic augmentation, an integrated procedure for massive irreparable RCT using an Achilles tendon-bone allograft (ATBA) was developed. Method: This was a retrospect study completed between October 2019 and April 2020. A 71-year-old woman with massive and irreparable rotator cuff tears was enrolled in our study. The ATBA was folded into a double-layer structure. The superior layer (proximal portion) served as a bridge patch to dynamic the glenohumeral joint, while the inferior layer (distal portion) served as the superior capsule to restore static stability of glenohumeral joint. To enhance biologic healing on the glenoid side, we fixed the calcaneus of the graft on the superior-posterior side of the superior glenoid rim. The recovery of shoulder function (including strength, range of motion, acromiohumeral interval, and fatty infiltration) was assessed at 6 months postoperation. Result: At 6-month follow-up, the patient's strength had improved significantly (from abduction of grade 3 preoperatively to grade 4 at 6 months). Radiographic analysis showed an increase in the acromiohumeral interval from 3 to 7 mm. Magnetic resonance imaging revealed an intact graft, with the thickness of the ligament part maintained (at 6-7 mm). Most importantly, recovery of atrophy and fatty infiltration of the supraspinatus were observed. No graft tears were observed on the glenoid side. Conclusion: This technique could provide a preferable treatment option by restoring shoulder kinematics and augmentating biological healing for patients with massive irreparable RCT.

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“…ACR has evolved as a natural progression of superior capsule reconstruction (SCR) described by Mihata et al [6][7][8] Excellent biomechanical and variable clinical outcomes have been achieved in patients with irreparable supraspinatus deficiency through restoration of superior glenohumeral stability and humeral head depression. 7,9,10 In irreparable subscapularis tears, anterior escape presents similar challenges. ACR using HDA provides a static check-rein to glenohumeral translation and terminal external rotation.…”

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confidence: 99%

Editorial Commentary: Anterior Capsular Reconstruction for Subscapularis Deficiency: The Definitive Treatment or a Helpful Adjunct?

Shin

Woodmass

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Anterior glenohumeral instability in the setting of irreparable subscapularis deficiency represents a difficult clinical scenario for the treating shoulder surgeon. Anterior capsular reconstruction with humeral dermal allograft improved glenohumeral translation stability and range of motion to near-normal values whereas pectoralis major tendon transfer was unable to do so. However, placement of a static spacer does not restore the dynamic force couple or shoulder kinematics. Further research is needed to evaluate the functional outcomes using this reconstruction technique.

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Superior capsule reconstruction using dermal allograft: early outcomes and survival

Cited by 68 publications

References 46 publications

Clinical Importance of Graft Integrity in Arthroscopic Superior Capsular Reconstruction Using a Minimally Invasively Harvested Midthigh Fascia Lata Autograft: 3-Year Clinical and Magnetic Resonance Imaging Outcomes

Clinical Importance of Graft Integrity in Arthroscopic Superior Capsular Reconstruction Using a Minimally Invasively Harvested Midthigh Fascia Lata Autograft: 3-Year Clinical and Magnetic Resonance Imaging Outcomes

Arthroscopic Superior Capsule Reconstruction and Rotator Cuff Repair to Restore Static and Dynamic Stability of the Shoulder

Editorial Commentary: Anterior Capsular Reconstruction for Subscapularis Deficiency: The Definitive Treatment or a Helpful Adjunct?

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