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Arthroscopic Superior Capsule Reconstruction (ASCR) vs. Latissimus Dorsi Transfer (LDT): a comparison of early clinical outcomes

      Introduction

      Arthroscopic superior capsule reconstruction (ASCR) has recently been introduced as an alternative to latissimus dorsi transfer (LDT) for treatment of irreparable rotator cuff tears in young patients. Our hypothesis was preliminary clinical outcomes for patients undergoing ASCR would not significantly differ from those of LDT patients for irreparable tears.

      Methods

      Patients who underwent either a LDT or ASCR with a minimum follow-up of 6 months (mean 26 month, range 6-92 month) were included. In the ASCR technique, a 3-mm acellular human dermal allograft was individually customized to the size of the defect. Objective, subjective, and demographic data were prospectively collected and retrospectively reviewed. ASES, SANE, QuickDASH, SF-12 and satisfaction outcome measures were collected pre and post-operatively.

      Results

      34 patients (13 women, 21 men, mean 52 ± 7 years) were included in this study. 16 patients underwent ASCR and 18 patients underwent LDT. Failure of the repair occurred in 1 patient in the ASCR group (6.2%), who suffered a graft tear shown on MRI at 141 days postoperatively, and 2 patients (11%) in the LDT group, both whom progressed to rTSA. Two additional patients (11%) in the LDT group had further surgery around 1-year postoperatively - an arthroscopic cuff repair and hardware removal operation. In those who did not fail, pain significantly decreased postoperatively (p<0.05) in both groups. Only patients who underwent ASCR had a statistically significant functional improvement (p=0.002 vs. p=0.161). Mean change in abduction and flexion were -7.3° and 0.6° respectively in the LDT group, compared to 56.0° and 21.7° respectively in the ASCR group. At final follow-up, satisfaction was a median 8/10 points in both groups.

      Conclusion

      Patients who underwent ASCR had significantly improved postoperative scores and range of motion, compared to those who underwent LDT, but longer follow-up is required.