A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear

Mihata, Teruhisa; Bui, Christopher; Akeda, Masaki; Cavagnaro, Matthew A.; Kuenzler, Michael; Peterson, Alexander B.; McGarry, Michelle H.; Itami, Yasuo; Limpisvasti, Orr; Neo, Masashi; Lee, Thay Q.

doi:10.1016/j.jse.2017.07.019

Cited by 159 publications

(153 citation statements)

References 14 publications

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“…Another study compared the biomechanical properties of a 3-mm-thick dermal allograft versus an 8-mm-thick fascia lata autograft in an SCR cadaveric model. 49 The allografts were significantly elongated by 15% during testing, whereas the fascia lata graft lengths were unchanged. The dermal allografts partially restored superior glenohumeral stability, whereas the fascia lata grafts completely restored superior glenohumeral stability.…”

Section: Discussionmentioning

confidence: 95%

Arthroscopic Superior Capsular Reconstruction With Acellular Porcine Dermal Xenograft for the Treatment of Massive Irreparable Rotator Cuff Tears

Polacek

2019

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To evaluate the short-term clinical outcomes and the complications related to arthroscopic superior capsular reconstruction (SCR) with acellular porcine dermal xenograft for the treatment of irreparable massive rotator cuff tears. Methods: A prospective observational study of patients treated with arthroscopic SCR for irreparable massive rotator cuff tears in the period from 2016 to 2017 was performed. Range of motion and Shoulder Pain and Disability Index (SPADI) scores were assessed preoperatively, at 6 months postoperatively, and at 12 months postoperatively. Results: A total of 20 shoulders in 19 patients, with an average age of 60 years, were included in the study. Twelve patients met the criterion for the minimal clinically important difference in the SPADI score. The mean SPADI score showed significant improvement from 51.3% to 10.4% at 1-year follow-up. Active abduction improved from 65.4 to 149.3 and active forward flexion improved from 68.6 to 151.4 at 1-year follow-up. The procedure had a 30% complication rate, including a 15% rate of immunologic rejection of the xenograft. Five patients underwent revision procedures, including arthroscopic debridement and removal of xenograft residuals, implantation of a balloon spacer, and revision SCR with a fascia lata autograft. Conclusions: Arthroscopic SCR with an acellular porcine dermal xenograft led to a successful outcome in 60% of cases. The procedure showed a quite high complication rate; the most severe cases were related to acute immunologic rejection of the xenograft. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 95%

Arthroscopic Superior Capsular Reconstruction With Acellular Porcine Dermal Xenograft for the Treatment of Massive Irreparable Rotator Cuff Tears

Polacek

2019

Arthroscopy, Sports Medicine, and Rehabilitation

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“…In this report, FL autograft is chosen for SCR because it is readily available and patients do not have any payment for the graft patch. Other advantages with FL autograft may include thicker spacing, less elongation [10,17] and no concerns in immune responses.…”

Section: Discussionmentioning

confidence: 99%

“…Incorporation of LHBT with FL patch may provide additional anterior-superior thickness and stabilizing effect against anterior translation. Secondly, FL patch could be secured antero-superiorly by suturing to LHBT instead of subscapularis tendon since anterior side-to-side suture may not be necessary or even arise concerns of shoulder stiffness owing to closure of rotator interval [17]. Thirdly, LHBT is rich in tenocytes that may imitate the physiological demands of humeral head stabilizers and is thus considered as a suitable graft for augmentation in RCT repair and reconstruction [18,19].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic superior capsule reconstruction using autologous fascia lata and biceps tendon augmentation

Hsu

Chiu

Weng

et al. 2020

Preprint

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Background While arthroscopic superior capsule reconstruction (SCR) has been recently introduced to treat irreparable rotator cuff tear with encouraging outcomes, graft options and fixation remain debated. The purpose of this article is to describe a novel technique and present preliminary results in using long head of biceps tendon (LHBT) as augmentation for SCR with fascia lata autograft. Methods Retrospective analysis was performed on 18 patients undergoing arthroscopic SCR with LHBT augmentation for irreparable rotator cuff tear between October 2017 and November 2019. Preoperative radiographic survey confirmed massive rotator cuff tear with moderate to severe muscle fatty infiltration and availability of LHBT. Fascia lata autograft harvested from ipsilateral thigh was folded and securely sutured. The folded fascia graft was then introduced through standard anterolateral portal and fixed to superior glenoid superiorly and greater tuberosity laterally with suture anchors. Anteriorly, fascia lata graft was sutured with proximal portion of LHBT instead of subscapularis tendon. A full coverage of rotator cuff defect by facial graft was then confirmed arthroscopically to allow tension-free suturing between posterior margin of fascia graft and residual infraspinatus tendon. Postoperative abduction brace and regular follow-up was arranged. Results Being intact in 4 patients and either partially torn or subluxed in 14 patients, LHBT in all 18 patients were available for augmentation surgery. Preliminary functional survey revealed encouraging outcomes with a mean follow-up of 11.5 months. Nine patients with more one year follow-up regained full forward elevation; ASES improved from 24.3 to 90.2. Acromiohumeral distance improved from 3.3 mm to 8.6 mm with radiographic analysis in those 9 patients. Conclusions Arthroscopically LHBT augmented SCR is a novel technique and can be one of feasible opinions for irreparable rotator cuff tear.

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“…In this report, FL autograft is chosen for SCR simply because it is readily available and patients do not have any payment for the graft patch. Other advantages with FL autograft may include thicker spacing, less elongation [8,15] and no concerns in immune responses.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic superior capsule reconstruction using autologous fascia lata and biceps tendon augmentation

Hsu

Chiu

Weng

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: While arthroscopic superior capsule reconstruction (SCR) has been recently introduced to treat irreparable rotator cuff tear with encouraging outcomes, graft options and fixation remain debated. The purpose of this article is to describe a novel technique and present preliminary results in using long head of biceps tendon (LHBT) as augmentation for SCR with fascia lata autograft.Methods: Retrospective analysis was performed on 18 patients undergoing arthroscopic SCR with LHBT augmentation for irreparable rotator cuff tear between October 2017 and November 2019. Preoperative radiographic survey confirmed massive rotator cuff tear with moderate to severe muscle fatty infiltration and availability of LHBT. Fascia lata autograft harvested from ipsilateral thigh was folded and securely sutured. The folded fascia graft was then introduced through standard anterolateral portal and fixed to superior glenoid superiorly and greater tuberosity laterally with suture anchors. Anteriorly, fascia lata graft was sutured with proximal portion of LHBT instead of subscapularis tendon. A full coverage of rotator cuff defect by facial graft was then confirmed arthroscopically to allow tension-free suturing between posterior margin of fascia graft and residual infraspinatus tendon. Postoperative abduction brace and regular follow-up was arranged.Results: Being intact in 4 patients and either partially torn or subluxed in 14 patients, LHBT in all 18 patients were available for augmentation surgery. Preliminary functional survey revealed encouraging outcomes with a mean follow-up of 11.5 months. Nine patients with more than one year follow-up regained full forward elevation; ASES improved from 24.3 to 90.2. Acromiohumeral distance improved from 3.3 mm to 8.6 mm with radiographic analysis in those 9 patients.Conclusions: Arthroscopically LHBT augmented SCR is a novel technique and can be one of feasible opinions for irreparable rotator cuff tear.

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A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear

Cited by 159 publications

References 14 publications

Arthroscopic Superior Capsular Reconstruction With Acellular Porcine Dermal Xenograft for the Treatment of Massive Irreparable Rotator Cuff Tears

Arthroscopic Superior Capsular Reconstruction With Acellular Porcine Dermal Xenograft for the Treatment of Massive Irreparable Rotator Cuff Tears

Arthroscopic superior capsule reconstruction using autologous fascia lata and biceps tendon augmentation

Arthroscopic superior capsule reconstruction using autologous fascia lata and biceps tendon augmentation

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