Purpose
To compare clinical and radiologic outcomes following superior capsular reconstruction
(SCR) using dermal allograft versus tensor fascia lata (TFL) autograft for massive
rotator cuff tears with a minimum 2-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 guidelines. Studies
evaluating clinical and radiologic 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 and the National Institutes of Health 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 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 American Shoulder and Elbow Surgeons
score were similar between groups (dermal allograft: 28.0-61.6; TFL autograft: 24.7-59.3).
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 following SCR (dermal allograft: 0.9-3.2
mm; TFL autograft: 0.3-3.6 mm) 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.
Conclusions
Acellular dermal allograft versus TFL autograft for SCR both demonstrate improved
VAS and American Shoulder and Elbow Surgeons scores, with increased values in flexion
and external rotation, and increased visual analog scale, although with high variability.
Both grafts demonstrate high rates of complications and failures at minimum 2-year
follow-up.
Level of Evidence
IV; systematic review of level II-IV studies.
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Article info
Publication history
Published online: January 16, 2023
Accepted:
January 4,
2023
Received:
November 13,
2022
Footnotes
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.
Identification
Copyright
© 2023 Published by Elsevier on behalf of the Arthroscopy Association of North America
