To assess postoperative changes in the thickness of the dermal allograft of the superior capsular reconstruction (SCR) and to evaluate the graft for the presence of intrasubstance pulsatile vessels.
A retrospective chart review was conducted to identify SCR patients who had ultrasound evaluations between May 2014 and February 2019. Data were collected and stratified based on time from surgery into 2 groups: 0 to 12 months and past the 12-month follow-up. The primary outcome measure was graft thickness at the articular margin–greater tuberosity interface (tuberosity measurement). Secondary measures included midsubstance graft thicknesses 0.5, 1.0, and 1.5 cm medial to the tuberosity measurement; status of lateral graft fixation; presence of pulsatile vessels; and American Shoulder and Elbow Society and visual analog scale scores.
Eighteen patients were included for analysis. The tuberosity measurement at final follow-up (mean 25 months, range 12-40 months) was (mean ± standard error [95% confidence interval (CI)]) 4.4 ± 0.2 mm (95% CI 4.0-4.8). This differed significantly from the midsubstance measurements: 0.5 cm: 3.6 ± 0.2 mm (95% CI 3.3-4.0, P = .008); 1.0 cm: 3.1 ± 0.2 mm (95% CI 2.7-3.4, P < .001); and 1.5 cm: 2.9 ± 0.2 mm (95% CI 2.6-3.2, P < .001). Ten constructs (56%) showed signs of pulsatile vessels in the first 12 months and all constructs were intact. ASES scores improved from 49.3 ± 4.0 (95% CI 41.6-57.1) preoperatively to 85.1 ± 2.9 (95% CI 79.4-90.8) (P < .001), and VAS scores decreased from 5.3 ± 0.6 (95% CI 4.2-6.5) preoperatively to 0.9 ± 0.3 (95% CI 0.3-1.5) at final follow-up (P < .001).
The SCR dermal allograft significantly thickens at its lateral aspect, presents with evidence of vasculature in most patients in the first year of implantation, and is not resorbed by the body.
Level of Evidence
Level IV – therapeutic case series.
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- Rotator cuff tears in the patient with paraplegia.J Shoulder Elbow Surg. 1993; 2: 64-69
- Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis.Arthroscopy. 2019; 35: 22-28
- Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.Am J Sports Med. 2018; 46: 2707-2716
- Superior capsule reconstruction for reinforcement of arthroscopic rotator cuff repair improves cuff integrity.Am J Sports Med. 2019; 47: 379-388
- Superior capsular reconstruction with arthroscopic rotator cuff repair in a “functional biologic augmentation” technique to treat massive atrophic rotator cuff tears [published online April 17, 2019]. Arthrosc Tech.https://doi.org/10.1016/j.eats.2019.01.004
- Arthroscopic superior capsular reconstruction for treatment of massive irreparable rotator cuff tears.Arthrosc Tech. 2015; 4: e637-e641
- Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.Arthroscopy. 2013; 29: 459-470
- Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft.Arthroscopy. 2018; 34: 93-99
- Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up.Am J Orthop. 2017; 46: 266-278
- Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2205-2213
- 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
- Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis.Am J Roentgenol. 2009; 192: 1701-1707
- A guide to ultrasound of the shoulder, part 2: the diagnostic evaluation.Am J Orthop. 2016; 45: 233-238
- Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterization of rotator cuff disorders: a systematic review and meta-analysis.Br J Sports Med. 2015; 49: 1316-1328
- Diagnostic accuracy of ultrasound for rotator cuff tears in adults: a systematic review and meta-analysis.Clin Radiol. 2011; 66: 1036-1048
- The PASTA Bridge: a technique for the arthroscopic repair of PASTA lesions.Arthrosc Tech. 2017; 6: e1645-e1652
- The evolution of the superior capsular reconstruction technique.(Int Congr Joint Restoration)Accessed January 8, 2019)
- Biological allograft healing after superior capsule reconstruction.J Shoulder Elbow Surg. 2018; 27: e387-e392
Accepted: June 22, 2019
Received: March 26, 2019
See commentary on page 3203
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
© 2019 by the Arthroscopy Association of North America
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- Editorial Commentary: Dermal Allograft: A Viable Allograft for Salvage Procedures in Treating Irreparable Rotator Cuff TearsArthroscopyVol. 35Issue 12
- PreviewOur experience with superior capsule reconstruction (SCR) has been successful in patients with isolated, irreparable, supraspinatus tears; however, we have found that bridging reconstruction may have a better role in treating patients with some cuff remnant. Our results are promising, and, although there is new evidence to show that dermal allografts can heal in the setting of rotator cuff deficiency, the basic principle of restoring anatomy should not be ignored. SCR has been accepted as a salvage procedure for irreparable cuff tears, with the precise indications being elucidated.