Case Report| Volume 35, ISSUE 10, P2959-2965, October 2019

Biomechanical and Histopathological Analysis of a Retrieved Dermal Allograft After Superior Capsule Reconstruction: A Case Report


      The purpose of this study was to evaluate biomechanical and histopathological results of a retrieved acellular human dermal allograft (AHDA) after superior capsule reconstruction (SCR). A 67-year-old man with pseudoparalysis was treated with SCR for an irreparable posterosuperior rotator cuff tear. The patient failed clinically 4.5 months postoperatively and elected to undergo reverse total shoulder arthroplasty (RTSA). At the time of RTSA, the AHDA was harvested. Biomechanical and histopathologic analyses were performed and compared to native grafts. Failure loads for the explanted graft and native grafts 1 and 2 were 158, 790, and 749 N, respectively. The stiffness values were 20.2, 73, and 100.5 N/mm. The displacement at failure for each graft was 10.1, 27.9, and 17.0 mm. Hematoxylin and eosin and Masson's trichrome staining revealed the presence of cells in all portions of the AHDA. The medial portion presented extensive cellular infiltration, the middle portion moderate, and the lateral portion the least infiltration. Although the only identifiable cells in the lateral portions were found in pockets on the interior of the graft, cells were mainly localized on the exterior. Postoperative cell incorporation could be found in acellular dermal allograft after SCR. However, biomechanical properties in the early postoperative phase were inferior compared with unimplanted allografts.
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        • 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. 2017; 33: e20
        • Hirahara A.M.
        • Andersen W.J.
        • Panero A.J.
        Superior capsular reconstruction: Clinical outcomes after minimum 2-year follow-up.
        Am J Orthop. 2017; 46: 266-272, 278
        • 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.
        Arthrosc J Arthrosc Relat Surg. 2018; : 1-10
        • Lee S.-J.
        • Min Y.-K.
        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 Sport Traumatol Arthrosc. 2018; 0: 1-9
        • Altintas B.
        • Higgins B.
        • Anderson N.
        • Millett P.J.
        Superior capsule reconstruction for the treatment for irreparable rotator cuff tears.
        Oper Tech Orthop. 2018; 28: 226-231
        • Pogorzelski J.
        • DelVecchio B.M.
        • Hussain Z.B.
        • Fritz E.M.
        • Godin J.A.
        • Millett P.J.
        Superior capsule reconstruction for massive rotator cuff tears—Key considerations for rehabilitation.
        Int J Sports Phys Ther. 2017; 12: 481-493
        • Turner N.J.
        • Pezzone M.A.
        • Brown B.N.
        • Badylak S.F.
        Quantitative multispectral imaging of Herovici’s polychrome for the assessment of collagen content and tissue remodeling.
        J Tissue Eng Regen Med. 2013; 7: 139-148
        • Summers A.P.
        • Koob T.J.
        The evolution of tendon—Morphology and material properties.
        Comp Biochem Physiol Part A Mol Integr Physiol. 2002; 133: 1159-1170
        • Robi K.
        • Jakob N.
        • Matevz K.
        • Matjaz V.
        The physiology of sports injuries and repair processes.
        Current Issues in Sports and Exercise Medicine. InTechOpen, London2013
        • Mihata T.
        • McGarry M.H.
        • Pirolo J.M.
        • Kinoshita M.
        • Lee T.Q.
        Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: A biomechanical cadaveric study.
        Am J Sports Med. 2012; 40: 2248-2255
        • Blickenstaff K.R.
        • Grana W.A.
        • Egle D.
        Analysis of a semitendinosus autograft in a rabbit model.
        Am J Sports Med. 1997; 25: 554-559
        • Dong S.
        • Huangfu X.
        • Xie G.
        • et al.
        Decellularized versus fresh-frozen allografts in anterior cruciate ligament reconstruction.
        Am J Sports Med. 2015; 43: 1924-1934
        • Yildiz F.
        • Bilsel K.
        • Pulatkan A.
        • et al.
        Comparison of two different superior capsule reconstruction methods in the treatment of chronic irreparable rotator cuff tears: A biomechanical and histologic study in rabbit models.
        J Shoulder Elb Surg. 2019; 28: 530-538
        • Gáspár K.
        • Erdei I.
        • Péter Z.
        • Dezsö B.
        • Hunyadi J.
        • Juhász I.
        Role of acellular dermal matrix allograft in minimal invasive coverage of deep burn wound with bone exposed—Case report and histological evaluation.
        Int Wound J. 2006; 3: 51-58
        • Omi T.
        • Kawanami O.
        • Matsuda K.
        • et al.
        Histological characteristics of the healing process of frozen skin allograft used in the treatment of burns.
        Burns. 1996; 22: 206-211
        • Wong A.K.
        • Schonmeyer B.H.
        • Singh P.
        • Carlson D.L.
        • Li S.
        • Mehrara B.J.
        Histologic analysis of angiogenesis and lymphangiogenesis in acellular human dermis.
        Plast Reconstr Surg. 2008; 121: 1144-1152
        • Li X.
        • Meng X.
        • Wang X.
        • et al.
        Human acellular dermal matrix allograft: A randomized, controlled human trial for the long-term evaluation of patients with extensive burns.
        Burns. 2015; 41: 689-699
        • Ngo M.D.
        • Aberman H.M.
        • Hawes M.L.
        • Choi B.
        • Gertzman A.A.
        Evaluation of human acellular dermis versus porcine acellular dermis in an in vivo model for incisional hernia repair.
        Cell Tissue Bank. 2011; 12: 135-145
        • Pauzenberger L.
        • Syré S.
        • Schurz M.
        “Ligamentization” in hamstring tendon grafts after anterior cruciate ligament reconstruction: A systematic review of the literature and a glimpse into the future.
        Arthroscopy. 2013; 29: 1712-1721
        • Janssen R.P.A.
        • Scheffler S.U.
        Intra-articular remodeling of hamstring tendon grafts after anterior cruciate ligament reconstruction.
        Knee Surg Sport Traumatol Arthrosc. 2014; 22: 2102-2108
        • Goradia V.K.
        • Rochat M.C.
        • Kida M.
        • Grana W.A.
        Natural history of a hamstring tendon autograft used for anterior cruciate ligament reconstruction in a sheep model.
        Am J Sport Med. 2000; 28: 40-46
        • Adams J.E.
        • Zobitz M.E.
        • Reach J.S.
        • An K.N.
        • Steinmann S.P.
        Rotator cuff repair using an acellular dermal matrix graft: An in vivo study in a canine model.
        Arthroscopy. 2006; 22: 700-709
        • Snyder S.J.
        • Arnoczky S.P.
        • Bond J.L.
        • Dopirak R.
        Histologic evaluation of a biopsy specimen obtained 3 months after rotator cuff augmentation with GraftJacket matrix.
        Arthroscopy. 2009; 25: 329-333
        • Utsunomiya H.
        • Uchida S.
        • Sekiya I.
        • Sakai A.
        • Moridera K.
        • Nakamura T.
        Isolation and characterization of human mesenchymal stem cells derived from shoulder tissues involved in rotator cuff tears.
        Am J Sports Med. 2013; 41: 657-668
        • Ide J.
        • Kikukawa K.
        • Hirose J.
        • Iyama K.
        • Sakamoto H.
        • Mizuta H.
        The effects of Fibroblast growth factor-2 on rotator cuff reconstruction with acellular dermal matrix grafts.
        Arthroscopy. 2009; 25: 608-616
        • Pogorzelski J.
        • Godin J.A.
        • Fritz E.M.
        • et al.
        The use of biological approaches in the treatment of shoulder pathology.
        JBJS Rev. 2017; 5: e5