Arthroscopic superior capsular reconstruction using a human dermal allograft in patients with and without preoperative pseudoparalysis

Abstract

Background Massive irreparable rotator cuff tears (RCT) may cause severe functional impairment and pain as a result of loss of superior humeral stability. Reconstruction of the superior capsule (SCR) has been reported to restore glenohumeral stability and function. Objective The purpose of this study was to investigate short-term functional and radiological outcome after arthroscopic SCR with a human dermal allograft for irreparable RCT. Methods In total, 21 patients (mean age 65.9 years, 50–77), who underwent arthroscopic SCR were prospectively enrolled in the present study. Magnetic resonance images (MRI) were obtained before and 12 months after surgery to evaluate graft survival. Functional and subjective outcome including the Constant score (CS), the American Shoulder and Elbow Surgeons score (ASES), and the Simple Shoulder Test (SST) was evaluated preoperatively as well as 3–6 and 12 months postoperatively and was compared between patients with and without preoperative pseudoparalysis. Complications were recorded. Results The MRI evaluation revealed intact grafts in 71.4% of patients 1 year postoperatively; these patients showed significant improvements from baseline to follow-up time points regarding the total CS and its subgroups pain, activity of living, range of motion, strength, ASES, and SST (p < 0.01). Pseudoparalysis was present in 57.1% of cases preoperatively, but was reversed in 100% of cases with intact graft at the 1‑year follow-up. The outcome was similar between groups at final follow-up. Complications occurred in 29% (one infection, five graft failures) of patients and were indications for treatment with reverse shoulder arthroplasty. Conclusion Arthroscopic SCR with a human dermal allograft in patients with irreparable RCT restored shoulder function and relieved pain in patients without and with preoperative pseudoparalysis.

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

“…This proportion is among the lowest in the range of reported graft tears across different studies of ASCR and is lower than the reported proportion of graft tears among most of the studies of ASCR that used an HDA. 10,14 In the current study, the statistically significant interrater reliability for the Goutallier classification of the supraspinatus muscle was within the range of reliability statistics reported in other settings, such as those reported for preoperative MRI of supraspinatus tendon tears. 30,44 In the study by Lippe et al, 30 the interrater reliability for the Goutallier classification was fair to moderate (kappa = 0.41) and improved to moderate (kappa = 0.53) when using the dichotomized Goutallier classification of the supraspinatus.…”

“…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.…”

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

“…Eight of these 9 studies reported a revision rate of 4% or less. ** In contrast, of the 16 clinical studies of ASCR that used allografts or xenografts published to date that reported a minimum follow-up of 6 months to 2 years, †† only 4 studies 13 , 29 , 41 , 50 reported an MRI evaluation of graft integrity for each of the enrolled patients, and the calculated graft tear proportion ranged from 18.5% to 50% in the first 6 to 12 months of follow-up. In the remaining 12 studies of ASCR that used allografts or xenografts, a selected subgroup of patients underwent MRI evaluation, resulting in a proportion that reflects only this selected subgroup’s graft tear rate.…”

Comparison of Outcomes After Arthroscopic Superior Capsule Reconstruction Versus Arthroscopic Partial Repair or Arthroscopic Debridement for Irreparable Rotator Cuff Tears

“…The surgical procedure has previously been described in detail. 16 , 30 , 40 All surgical procedures were performed with patients in the beach-chair position under general anesthesia and interscalene plexus blockade. DB of the tear margins, comprehensive bursectomy, subacromial decompression, opening of the rotator interval, and tenotomy of the long head of the biceps tendon (LHBT) were performed in all patients.…”

“… 3 – 6 Alternatively, Hirarara et al 30 , 31 proposed the use of an acellular dermal allograft for SCR. 16 A recently published systematic review reported good to excellent clinical outcomes in patients with irreparable RC tears undergoing SCR using a fascia lata autograft or a dermal allograft at mean short-term follow-up of 15 to 48 months. 2 Moreover, return to sport after SCR was reported in up to 100% of the cohort on the competitive and recreational levels.…”