Arthroscopic Superior Capsular Reconstruction of the Shoulder Using Dermal Allograft

Abstract

Irreparable massive cuff tears in young patients pose a difficult problem for shoulder surgeons. Arthroscopic superior capsular reconstruction has shown promise in recent years in the treatment of this challenging patient population. The majority of the literature is limited to surgical techniques. The authors present the 2-year clinical outcomes of 25 patients undergoing arthroscopic superior capsular reconstruction with dermal allograft from a single center. The Oxford Shoulder Score and range of motion were assessed preoperatively and then at 3 to 6 months, 1 year, and 2 years following surgery. Patient satisfaction was recorded at final follow-up. Magnetic resonance imaging was performed at 3 months postoperatively to assess graft integrity. All patients were available at 1-year follow-up, and 23 were available at 2 years. The mean Oxford Shoulder Score improved by a minimum of 10 points at all time points compared with preoperatively. The mean forward flexion and abduction improved by 20° and external rotation by 7°. Revision to reverse shoulder arthroplasty was seen in 3 patients (12%). Graft failure was seen in 4 patients (16%). Overall, 20 patients had successful outcomes at 1 year (80%) and 18 patients had successful outcomes at 2 years (72%). Superior capsular reconstruction offers a safe and effective short-term bridging option for young patients with irreparable supraspinatus tears in the absence of glenohumeral arthritis. However, long-term outcome studies are required to evaluate the true clinical effectiveness and failure rates. [ Orthopedics . 2020;43(4):215–220.]

A Scoping Review of Postoperative Rehabilitation Protocols After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears

“…The immobilization without pROM ranged from 0 weeks (immediate pROM) to 6 weeks postoperatively. Seven articles 5 , 7 , 12 , 21 , 28 , 29 , 34 reported the pROM that started within the first week at post-SCR as tolerated or comfortable. The immobilization without pROM was 2 to 4 weeks in 6 articles 10 , 15 , 25 , 27 , 31 , 32 and >4 weeks in 8 articles 2 , 4 , 11 , 16 , 18 , 19 , 23 , 36 (>6 weeks in 5 articles 11 , 16 , 18 , 19 , 36 ).…”

“…The start of the aROM phase ranged from postoperative 3 weeks to postoperative 12 weeks. Six articles started aROM by postoperative week 8 (3-6 weeks in 2 studies 10 , 28 and 6 weeks in 4 studies 5 , 12 , 21 , 25 ), while 7 studies did not recommend aROM by week 8 (week 8 in 3 studies, 27 , 29 , 34 10-12 weeks in 2 studies, 2 , 18 and 12 weeks in 2 studies 11 , 19 ).…”

Recent advances and future trends in shoulder arthroscopy

“…Clinical outcomes using a dermal allograft at 2 years have shown successful outcomes in 72%; graft failure was found in 16%; and revision to replacement was necessary in 12% of patients. [33] A review of clinical outcomes comparing fascia lata autograft and human dermal allograft in arthroscopic SCR for irreparable rotator cuff tears suggested significant and clinically important improvements in clinical outcomes in both groups; however, the graft tear rate was found to be high (fascia lata autograft 5-32% and human dermal allograft 20-75%.). [34]…”

Superior Capsular Reconstruction With Double Bundle of Long Head Biceps Tendon Autograft: The “Box” Technique

“… 2 , 3 , 4 Recently, several new graft sources and techniques for SCR have emerged. 5 , 6 , 7 , 8 , 9 …”

“…[2][3][4] Recently, several new graft sources and techniques for SCR have emerged. [5][6][7][8][9] In young or active patients with massive RCT without glenohumeral arthritis, joint preservation is the preferable treatment principle. 10 If complete anatomical repair is not possible, partial repair combined with SCR leads to improved functional outcome and active range of motion for active elevation and external rotation.…”