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Acellular Dermal Allograft and Tensor Fascia Lata Autograft Show Similar Patient Outcome Improvement, and high Rates of Complications and Failures at a Minimum Two-Year Follow-up: A Systematic Review

Published:January 16, 2023DOI:https://doi.org/10.1016/j.arthro.2023.01.003

      Abstract

      Purpose

      To compare clinical and radiological outcomes following superior capsular reconstruction (SCR) using dermal allograft versus tensor fascia lata (TFL) autograft for massive rotator cuff tears with a minimum two-year follow-up.

      Methods

      A literature search was performed by querying Scopus, EMBASE, and PubMed computerized databases from database inception through September 2022 in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating clinical and radiological outcomes, as well as complications following SCR for the treatment of massive rotator cuff tears were included. Study quality was assessed via the Newcastle-Ottawa Scale (NOS) and the National Institute of Health (NIH) Quality Assessment. The mean change from preoperative to postoperative values (delta) was calculated for each outcome.

      Results

      Seventeen studies, consisting of 519 patients were identified. Mean duration of follow-up ranged from 24 to 60 months. Mean reduction in visual analog scale (VAS) pain score ranged from 2.9 to 5.9 points following use of dermal allograft, and 3.4 to 7.0 points following TFL autograft reconstruction. Mean improvements in ASES score were similar between groups (dermal allograft: 28.0 to 61.6; TFL autograft: 24.7 to 59.3). The mean increase in forward flexion ranged from 31° to 38° with dermal allograft, versus 19° to 69° with TFL autograft. Average improvement in active external rotation with dermal allograft ranged from -0.4° to 11° and from 2° to 22.4° using TFL autograft. A similar change in acromiohumeral distance (AHD) following SCR (dermal allograft: 0.9 to 3.2mm; TFL autograft: 0.3 to 3.6mm) was appreciated. The rate of complications within the dermal allograft group ranged from 4.5% to 38.2% versus 13.3% to 86.4% following TFL autograft. Failure rate ranged from 4.5 to 38.2% following dermal allograft versus 4.5 to 86.4% with TFL autograft.

      Conclusion

      Acellular dermal allograft versus TFL autograft for SCR both demonstrate improved VAS and ASES scores, with increased values in flexion and external rotation, and increased AHD, although with high variability. Both grafts demonstrate high rates of complications and failures at minimum two-year follow-up.

      Level of Evidence

      IV; Systematic Review of level II-IV studies.
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