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Early MRI Findings of Arthroscopic Superior Capsule Reconstruction (ASCR): How to Prevent Early Failure

      Introduction

      Find out the early graft failure rate and analyze the factors after ASCR.

      Methods

      From June 2013 to April 2016, consecutive patients who underwent ASCR in our institution were queried. Indication for ASCR was patients with massive cuff tear that were deemed irreparable after arthroscopic examination. Any patients who were lost to follow-up, or did not have MRI postoperatively were excluded. When ASCR were determined after arthroscopic examination, bursectomy and acromioplasty are done. Ipsilateral autogenous fascia lata was harvested and prepared to be folded in 2-3 layers. Two or three anchors are inserted on glenoid and greater tuberosity, respectively. During regular postoperative follow-up, MRI was used to check the integrity of graft. Graft tear was defined as loss of continuity on T2 coronal image. Patient's age, failure site and preoperative tear size was compared between failure group and intact group.

      Results

      A total of 28 patients underwent ASCR, 2 patients were lost follow-up. A mean 5 months postoperative MRI was analyzed for graft tear. Average age of patients was 64.8 years ,and consists of 9 male and 17 female. Eight patients out of 26 patients show graft tear. Most of these failure were early cases of the study. Six patients showed failure of graft at lateral anchor area, and two patients showed mid-substance graft failure. Mean age of failure group was 70.9 years old which was higher than the intact group (62.1 years).

      Conclusion

      Early failure rate by MRI study was 30.7%. Most failures occurred at the lateral anchor site presumably because of failure to match the graft size which led to excessive tension. Also age was a risk factor for early failure. To prevent these early failure, it is important to harvest adequate graft and acquire reconstruction with minimum tension. Older patients may need different approach considering the relatively high failure rate.