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Shoulder Superior Capsular Reconstruction Hybrid Graft Thickness Greater Than Preoperative Acromiohumeral Distance Increases Graft Retear Rate and Subacromial Erosion

Published:December 20, 2021DOI:https://doi.org/10.1016/j.arthro.2021.11.046

      Purpose

      To evaluate the impact of graft thickness on clinical outcomes and graft retear after superior capsular reconstruction (SCR) using a hybrid graft combining both fascia lata autograft and dermal allograft in patients with massive rotator cuff tear (MRCT).

      Methods

      Between January 2017 and February 2019, this study enrolled 58 patients with MRCT who underwent SCR using a hybrid graft combining both fascia lata autograft and dermal allograft. We evaluated clinical outcomes and compared differences between the graft intact and the graft retear group. Moreover, subgroup analysis was performed for patients having a preoperative acromiohumeral distance (AHD) less than or equal to the used graft thickness (group 1) and the results were compared with those for preoperative AHD greater than the used graft thickness (group 2).

      Results

      Fifty-five patients who underwent MRCT with a mean age of 65.1 ± 5.7 years old were followed up during a mean period of 30.5 ± 6.5 (range, 24-37) months. There were significant differences in clinical outcome measures preoperatively and postoperatively (P < .05). There were no significant differences in clinical outcomes between the graft intact and graft retear groups (P > .05). The subgroup analysis revealed that the retear (68.6% vs 30.4%, P = .004) and subacromial erosion rates (91.4% vs 60.9%, P = .005) were significantly greater in for patients having a preoperative AHD less than or equal to the used graft thickness (group 1).

      Conclusions

      SCR using a hybrid graft combining both fascia lata autograft and dermal allograft is promising with improved clinical scores (P < .05) irrespective of the graft integrity. The use of a graft with a thickness greater than a patient’s preoperative AHD could increase graft retear and subacromial erosion rates after SCR. However, there was no significant difference in clinical outcomes according to the relationship between used graft thickness and preoperative AHD.

      Level of Evidence

      Level IV, therapeutic case series.
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