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Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft

Published:November 13, 2017DOI:https://doi.org/10.1016/j.arthro.2017.08.265

      Purpose

      The purpose of this study was to evaluate the short-term outcomes of arthroscopic superior capsule reconstruction (SCR) with dermal allograft for the treatment of irreparable massive rotator cuff tears (MRCTs).

      Methods

      A multicenter study was performed on patients undergoing arthroscopic SCR for irreparable MRCTs. The minimum follow-up was 1 year. Range of motion and functional outcome according to visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV) score were assessed preoperatively and at final follow-up. Radiographs were used to evaluate the acromiohumeral interval (AHI).

      Results

      Fifty-nine patients with a mean age of 62.0 years had a minimum follow-up of 1 year. Twenty-five patients (42.4%) had a prior rotator cuff repair. Forward flexion improved from 130° preoperative to 158° postoperative, and external rotation improved from 36° to 45°, respectively (P < .001). Compared with preoperative values, the VAS decreased from 5.8 to 1.7, the ASES score improved from 43.6 to 77.5, and the SSV score improved from 35.0 to 76.3 (P < .001). The AHI was 6.6 mm at baseline and improved to 7.6 mm at 2 weeks postoperatively but decreased to 6.7 mm at final follow-up. Based on postoperative magnetic resonance imaging, 45% (9 of 20) of the grafts demonstrated complete healing. Forty-six (74.6%) cases were considered a success. Eleven patients (18.6%) underwent a revision procedure including 7 reverse shoulder arthroplasties.

      Conclusions

      Arthroscopic SCR using dermal allograft provides a successful outcome in approximately 70% of cases in an initial experience. The preliminary results are encouraging in this difficult to manage patient population, but precise indications are important and graft healing is low in our initial experience.

      Level of Evidence

      Level IV, case series.
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      Linked Article

      • Editorial Commentary: Superior Capsule Reconstruction With Dermal Allograft: Effective Marketing or the Real Deal?
        ArthroscopyVol. 34Issue 1
        • Preview
          The young patient with a massive, irreparable rotator cuff tear is a challenging problem. Not only is this patient population demanding, but of the few surgical options that exist to manage this problem, each have their own unique limitations; as such, the orthopaedic community continues to search for a treatment that maximizes outcome and durability, while minimizing risk and preserving the native shoulder. Over the past few years, there has been considerable interest in a new surgical technique: the superior capsule reconstruction (SCR).
        • Full-Text
        • PDF
      • Editorial Commentary: Superior Capsule Reconstruction: Graft Healing for Success
        ArthroscopyVol. 34Issue 1
        • Preview
          In my experience, after superior capsule reconstruction for irreparable rotator cuff tears, if the graft heals, we can expect a successful outcome, such as an American Shoulder and Elbow Surgeons score of more than 90 points and a visual analog scale score of less than 1.0. To decrease the graft tear rate after surgery, I have found that a thicker, stiffer graft than can be achieved with a dermal allograft alone is required to restore superior stability in the glenohumeral joint. Furthermore, the graft size should be determined precisely from the size of the defect in the rotator cuff tendons.
        • Full-Text
        • PDF