Purpose
To determine the clinical outcomes of arthroscopic superior capsular reconstruction
(ASCR) using either fascia lata autograft or human dermal allograft for irreparable
rotator cuff tears (IRCTs).
Methods
A systematic review was performed according to PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-analyses) guidelines by searching the MEDLINE, Embase,
and Cochrane Library databases through January 31, 2019. The inclusion criteria were
as follows: 5 or more consecutive patients who underwent ASCR for IRCTs; clinical
outcome measures reported at a minimum follow-up of 12 months; and magnetic resonance
imaging assessment at a minimum follow-up of 6 months. The methodologic quality was
evaluated using the Methodological Index for Non-randomized Studies (MINORS). A narrative
synthesis of data was performed. Mean outcome improvements were compared with minimal
clinically important differences.
Results
We identified 7 eligible studies that included 344 shoulders in 338 patients who underwent
ASCR for IRCTs (all Level IV studies). The mean MINORS score was 12.3 ± 1.60. Of the
7 studies, 5 had a high risk of bias (MINORS score ≤12): 2 studies using only fascia
lata autograft and 3 studies using only human dermal allograft. The mean age of patients
ranged from 59.4 to 66.9 years. The mean follow-up time ranged from 12 to 48 months.
All studies reported statistically significant and clinically important mean improvements
in active elevation (range of means, 28°-56°), the Constant score (range of means,
12-47.1 points), or the American Shoulder and Elbow Surgeons score (range of means,
29.3-56 points). In total, 218 shoulders underwent postoperative magnetic resonance
imaging. The graft tear rate reported in studies using fascia lata autograft (181
shoulders) ranged from 5% to 32%, whereas the values reported in studies using human
dermal allograft (37 shoulders) ranged from 20% to 75%.
Conclusions
ASCR using either fascia lata autograft or human dermal allograft leads to significant
and clinically important improvements in clinical outcomes in IRCT patients at 12 months
or later.
Level of Evidence
Level IV, systematic review of Level IV studies.
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Article Info
Publication History
Published online: December 12, 2019
Accepted:
August 14,
2019
Received:
March 21,
2019
Footnotes
See commentary on page 592
The authors report the following potential conflicts of interest or sources of funding: C.I.d.C.A. receives support from Smith & Nephew, ConMed, Lusopalex, Zimmer- Biomet , and Arthrex . A.C.L.P.G.Â. receives support from Smith & Nephew, ConMed, Arthrex , Zimmer- Biomet , and Acumed . N.F. receives support from Smith & Nephew, Grunenthal, Arthrex , Zimmer- Biomet , and MBA. N.S. receives support from Smith & Nephew and Arthrex . Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
