Failure Rate After Superior Capsular Reconstruction With Achilles Tendon–Bone Allograft for Irreparable Rotator Cuff Tears

Abstract

Background: Superior capsular reconstruction (SCR) is an alternative to reverse shoulder arthroplasty for irreparable rotator cuff tears (IRCTs). The reconstructed capsule acts as a static restraint to prevent superior migration of the humeral head. Traditional SCR uses a fascia lata autograft, which has shown failure at the greater tuberosity. An Achilles tendon–bone allograft has been proposed to improve the failure rate. Purpose: To evaluate the surgical outcomes of SCR using an Achilles tendon–bone allograft for the treatment of IRCTs. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively evaluated 6 patients with massive IRCTs who underwent SCR using an Achilles tendon–bone allograft between January 2017 and January 2018. Clinical outcomes were assessed using range of motion, the American Shoulder and Elbow Surgeons score, and the visual analog scale for pain. The acromiohumeral distance and the status of graft integrity were evaluated using serial magnetic resonance imaging. Second-look arthroscopy surgery was performed to evaluate graft integrity at the mean of 7.5 months postoperative. Results: The mean ± SD clinical follow-up period was 14.5 months (range, 12-17 months). The American Shoulder and Elbow Surgeons and visual analog scale scores improved from 42.8 ± 11.9 and 4.0 ± 1.2 to 62.1 ± 14.7 and 2.8 ± 1.4, respectively. Forward flexion and external rotation improved from 98° ± 36° and 58° ± 4° to 123° ± 20° and 39° ± 8°, respectively. The acromiohumeral distance improved from 3.9 ± 0.8 mm to 6.4 ± 2.2 mm at final follow-up. However, second-look arthroscopy at a mean of 7.6 months postoperatively confirmed a graft failure rate of 83.3%. Conclusion: SCR using an Achilles tendon–bone allograft for the treatment of IRCTs had a high graft failure rate among patients in this case series.

Calcaneum-Achilles Tendon Allograft for Massive Posterosuperior Rotator Cuff Lesion With Bony Deficiency

“…However, these satisfactory results run against the findings by Kholinne et al. 24 In a case series of 6 patients, the authors studied the validity of CalATA for superior capsular reconstruction in the management of irreparable massive cuff injuries. The rationale behind the study is based on animal studies 26 , 27 that showed that the healing process at the bone-to-bone interface is more favorable than at the tendon-to-bone interface.…”

Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction

“…Graft integrity has been shown to be an important independent factor to improve postoperative outcomes after SCR, 22 and graft healing has been proposed to be critical in improving patient outcomes. 39 Ciampi et al 8 demonstrated that mesh augmentation of rotator cuff repair significantly improved the clinical outcomes and reduced the retear rate.…”

Achilles Tendon–Bone Block Allograft for Massive Rotator Cuff Tears With Bony Deficiency of the Greater Tuberosity: A Minimum 2-Year Follow-up Study

“…As such, we were able to employ our technique, in which we utilized the graft as an augmentation to a rotator cuff repair, with a large surface of contact between the native tendon and the allograft. This technique differs substantially from those of Kholinne et al, 15 who utilized the allograft tendon as an SCR, and Moore et al, 28 who sewed the allograft to the ends of the native rotator cuff tissue. The rotator cuff repair may explain the improved clinical outcomes, as well as the graft integration noted on histology.…”

“…There are also studies that have utilized an ATBA for SCR in irreparable rotator cuff tears. 15,16,24 Kholinne et al 15 published a case series of 6 patients with massive irreparable rotator cuff tears in which an ATBA was used for SCR. There was a high graft failure rate at 1 year (83%), and only 50% of the patients had improvements in the ASES scores that met the minimal clinically important difference of 21.0 points.…”

“…20 There has also been growing interest in utilizing the Achilles tendon allograft for superior capsular reconstruction (SCR). 15,16,24 However, there remains a paucity of clinical literature analyzing outcomes of an ATBA for concomitant massive rotator cuff tears and greater tuberosity bone loss.…”