Superior Capsular Reconstruction: Fascia Lata Versus Acellular Dermal Allograft: A Systematic Review

Abstract

We systematically reviewed the literature to compare the clinical and radiologic outcomes and retear rates of superior capsular reconstruction (SCR) using fascia lata autograft (FLA) versus human dermal allograft (HDA) in cases of massive irreparable rotator cuff tears. Methods: Searches of Pub Med and Cochrane Library identified clinical studies addressing SCR using FLA and HDA. Two reviewers independently screened the titles, abstracts and full texts to extract data from eligible studies. Reported outcome measures were descriptively analyzed. Results: A total of 6 studies with 2 study groups satisfied the inclusion criteria. The number of shoulders in the HDA group was 155, and in the FLA group, the number was 140 shoulders. The mean age at time of surgery for the HDA group and the FLA group was 60.49 years and 65.8 years, respectively, and the mean follow-up was 15.2 months and 44.6 months, respectively. Active elevation improved from of 121-130 to 158-160 in the HDA group and from 74.8-133 to 130.4-146 in the FLA group. Active external rotation improved from 36-45 in the HDA group and from 13-28 to 30-43 in the FLA group. The Visual Analog Scale for pain improved from 4-6.25 to 0.38-1.7 points in the HDA group, whereas in the FLA group, it improved from 6-2.5 points. In the HDA group, American Shoulder and Elbow Surgeons scores improved from 42-52 to 77.5-86.5, whereas in the FLA group scores improved from 35-54.4 to 73.7-94.3. The acromiohumeral distance improved in both groups. The retear rate was 3.4%-55% in the HDA group and 4.5%-29% % in the FLA group. Conclusions: Arthroscopic SCR for massive, irreparable rotator cuff tears using both fascia lata allograft and human dermal allograft leads to improvement in clinical outcomes and radiologic outcomes. There is a lower retear rate in fascia lata allografts. The current literature is heterogeneous and has low levels of evidence. Level of Evidence: Level IV, systematic review of level IV studies.

Superior Capsular Reconstruction of the Shoulder Using the Long Head of the Biceps Tendon: A Systematic Review of Surgical Techniques and Clinical Outcomes

“…SCR with the use of the LHBT autograft yielded similar results with the traditional SCR in the direct comparison performed by Kocaoglu et al, including the retear rates (3/14 for the LHBT SCR versus 2/12 for SCR with a fascia lata) [26]. SCR graft retear rates have been reported in the literature and they range from 3.4-55% for human dermal allograft and 4.5-29% for fascia lata autografts, revealing less satisfactory results in the long-term [6,31]. Mihata et al reported that the success of the SCR depends mainly on graft healing [31].…”

“…This static graft acts as a restraint against the superior migration of the humeral head, thus preventing the progression of RC tear arthropathy and yielding promising functional outcomes [ 1 ]. Several authors proposed the use of acellular dermal allograft to avoid the possible autograft donor site morbidity of the original technique, although biological healing between bone and dermal allografts is not yet fully investigated [ 6 ].…”

The Arthroscopic Intra-Articular Stabilization of the Shoulder for Irreparable Rotator Cuff Tear: A New Technique Proposal

“…To date, fascia lata and human dermal graft could be used in SCR (23)(24)(25)(26). However, concerns about cost, donor site morbidity in case of autograft, increased surgical time and the significantly elongation of dermal graft during test need to be considered (27). Furthermore, an unstable shoulder works with an altered biomechanics and will undergo arthritic degeneration (15,16,19).…”

Graft Healing Is More Important Than Graft Technique: Superior Capsular Reconstruction Versus Bridging Grafts—A Prospective Randomized Controlled Trial

“…All patient reported outcomes improved between the pre-operative and 24-month postoperative assessments in both groups (SCR vs BG). The mean ASES, WORC and DASH scores at 24 months post-operatively were 77.9 +/-19.9 (95%CI 69.2 -86.4), 69.5 +/-24.5 (95%CI 58.9 -80.1) and 25…”