Advertisement

Regarding “Arthroscopic Superior Capsular Reconstruction With Acellular Dermal Allograft for the Treatment of Massive Irreparable Rotator Cuff Tears”

      I wish to thank and congratulate Pennington et al.
      • Pennington W.T.
      • Bartz B.A.
      • Pauli J.M.
      • Walker C.E.
      • Schmidt W.
      Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: Short-term clinical outcomes and the radiographic parameter of superior capsular distance.
      for their article titled “Arthroscopic Superior Capsular Reconstruction With Acellular Dermal Allograft for the Treatment of Massive Irreparable Rotator Cuff Tears: Short-Term Clinical Outcomes and Radiographic Parameters of Superior Capsule Distance.” In this article, the authors published their short-term clinical and radiographic outcome following superior capsular reconstruction. There is, however, an inconsistency in this article that I believe is important to address.
      In the Methods section of the article, the authors state the following: “Postoperative advance imaging with MRI [magnetic resonance imaging] was only performed on those patients who expressed dissatisfaction with their level of pain, or who had insufficient functional improvement in terms of strength and range of motion.”
      • Pennington W.T.
      • Bartz B.A.
      • Pauli J.M.
      • Walker C.E.
      • Schmidt W.
      Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: Short-term clinical outcomes and the radiographic parameter of superior capsular distance.
      The issue is that in the Results section under the Failure subheading, it is stated: “Currently, we are obtaining advanced imaging of all of our patients to evaluate graft incorporation; however, we have had 3 radiographically revealed graft failures on MRI in patients reporting dissatisfaction.”
      • Pennington W.T.
      • Bartz B.A.
      • Pauli J.M.
      • Walker C.E.
      • Schmidt W.
      Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: Short-term clinical outcomes and the radiographic parameter of superior capsular distance.
      The following is further stated in the same section: “These patients represent a failure rate of 4.5% (4/88 shoulders). All 3 radiographic failures we observed occurred at the greater tuberosity of the humerus attachment site.”
      • Pennington W.T.
      • Bartz B.A.
      • Pauli J.M.
      • Walker C.E.
      • Schmidt W.
      Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: Short-term clinical outcomes and the radiographic parameter of superior capsular distance.
      Thus, in the Methods section, the authors report that MRI was only obtained in “patients with dissatisfaction,” whereas in the Results section, readers may be left with an impression that MRI was obtained in all patients to evaluate graft incorporation. I believe that it is very important for this to be clarified, because it is stated that there were “3 radiographic failures.” What is important is 3 of how many patients? If it is 3 of the 4 dissatisfied patients (if only the dissatisfied patients had postoperative MRI), then the radiographically MRI failures rates may have been much higher if all patients (satisfied and dissatisfied) had postoperative MRIs, as we know from previous publications in which all patients were scanned that patients have significant improvement in their outcome scores despite a high rate of incomplete healing with postoperative superior capsular reconstruction.
      • Denard P.J.
      • Brady P.C.
      • Adams C.R.
      • Tokish J.M.
      • Burkhart S.S.
      Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft.
      If all patients had postoperative MRI leading to a radiological MRI failure rate of 3 in 88 (which is extremely low), then the Methods section should be corrected. Otherwise, the Results section should be clarified so that one is not left with the impression that all patients had advanced imaging with MRI after surgery to evaluate graft incorporation.

      Supplementary Data

      References

        • Pennington W.T.
        • Bartz B.A.
        • Pauli J.M.
        • Walker C.E.
        • Schmidt W.
        Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: Short-term clinical outcomes and the radiographic parameter of superior capsular distance.
        Arthroscopy. 2018; 34: 1764-1773
        • Denard P.J.
        • Brady P.C.
        • Adams C.R.
        • Tokish J.M.
        • Burkhart S.S.
        Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft.
        Arthroscopy. 2018; 34: 93-99

      Linked Article