Fascia Lata Autograft Versus Human Dermal Allograft in Arthroscopic Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears: A Systematic Review of Clinical Outcomes

Azevedo, Clara de Campos; Andrade, Renato; Ângelo, Ana Catarina; Espregueira-Mendes, João; Ferreira, Nuno; Sevivas, Nuno

doi:10.1016/j.arthro.2019.08.033

Cited by 52 publications

(40 citation statements)

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“…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.…”

Section: Discussionsupporting

confidence: 81%

“…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%

“…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. 32 The correlations of graft integrity with clinical outcomes or graft tears as a cause of failure of ASCR have not been established.…”

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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: Discussionsupporting

confidence: 81%

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confidence: 99%

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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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“…de Campos Azevedo, Andrade, Leiria Pires Gago Ângelo, Espregueira-Mendes, Ferreira, and Sevivas attempt to determine whether the literature supports an optimal graft selection choice in their article entitled "Fascia Lata Autograft Versus Human Dermal Allograft in Arthroscopic Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears: A Systematic Review of Clinical Outcomes." 10 The authors systematically identified 7 level IV studies that included 344 shoulders with a mean follow-up of 1 to 4 years that analyzed arthroscopic SCR outcomes using either a fascia lata autograft or dermal allograft. Predictably, consistent with pretty much every systematic review that I have ever read, reviewed, or performed, bias and heterogeneity were high, which limited comparative analysis and the ability to make valid conclusions.…”

Section: See Related Article On Page 579mentioning

confidence: 99%

Editorial Commentary: Off the Hip or Off the Shelf? An Analysis of Autograft and Allograft as a Graft Source for Shoulder Superior Capsular Reconstruction

Dilisio¹

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Superior capsular reconstruction can effectively relieve pain and improve function in the rotator cuffedeficient shoulder, but the optimal graft has not been determined. Multiple authors have demonstrated the effectiveness of the procedure, but bias and heterogeneity between studies do not allow valid comparative analysis of graft type. Until we can adequately compare outcomes, complications, or survival, graft availability and cost may be the greatest determinants of graft selection.

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“…[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]…”

Section: Superior Capsular Reconstructionmentioning

confidence: 99%

Recent advances and future trends in shoulder arthroscopy

DeNiese¹,

Bhatia²

2020

JASSM

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Shoulder arthroscopy has evolved significantly over the past decade. Treatment algorithms have evolved in sync with results from cadaveric, biomechanical, and clinical studies, and newer minimally invasive and biomechanically proven surgical techniques have replaced suboptimal procedures. Advances in arthroscopy have influenced three key aspects of shoulder problems: Anterior instability, rotator cuff tears, and osteoarthritis. A new frontier of “endoscopic” extra-articular procedures has evolved and these procedures have convincingly replaced traditional open surgeries. The current evidence suggests a growing trend for arthroscopic procedures in joint preservation and restoration.

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Fascia Lata Autograft Versus Human Dermal Allograft in Arthroscopic Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears: A Systematic Review of Clinical Outcomes

Cited by 52 publications

References 41 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

Editorial Commentary: Off the Hip or Off the Shelf? An Analysis of Autograft and Allograft as a Graft Source for Shoulder Superior Capsular Reconstruction

Recent advances and future trends in shoulder arthroscopy

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