Purpose
To report the results of the arthroscopic superior capsule reconstruction (ASCR) technique
with a combined fascia lata autograft and synthetic scaffold patch graft for irreparable
massive rotator cuff tears (RCTs).
Methods
The period for this retrospective study was between December 2016 and December 2020.
The criteria for inclusion were patients treated arthroscopically for an incompletely
reparable massive RCT (dimension > 5 cm and two tendons fully torn, intact or reparable
subscapularis tendons and teres minor tendon with or without irreparable infraspinatus,
a radiological Hamada classification between grade 0 and 4, and a minimum 24-month
postoperative follow-up).. Clinical outcomes were evaluated pre-operatively and at
a final follow-up by a visual analog scale (VAS) for pain and range of motion along
with the American Shoulder and Elbow Surgeons score (ASES), the University of California
Los Angeles score (UCLA), and the Constant–Murley score (CMS). Radiological outcomes
were assessed according to the rotator cuff arthropathy (RCA) and the acromiohumeral
distance (AHD) stages. Graft integrity and muscle fatty infiltration were evaluated
by magnetic resonance imaging (MRI).
Results
A total of 43 patients were enrolled in the study with a mean follow-up duration of
45.6 months (range 24 to 64). All clinical scores also improved at the two-year follow-up
(mean VAS 0.7 [SD 0.7] vs. 5.4 [SD 1.1], P < 0.001; mean ASES 92.6 [SD 8.0] vs. 34.8 [SD 13.4], P < 0.001; mean UCLA 31.5 [SD 3.9] vs. 11.0 [SD 3.2], P < 0.001; and mean CMS 86.6 [SD 7.2] vs. 40.0 [SD 11.6], P < 0.001), and 39 of 43 fascia lata grafts were fully intact on MRI (91%).
Conclusions
ASCR with a combined fascia lata autograft and synthetic scaffold patch graft resulted
in good functional outcomes, with a high rate of graft healing at the two-year follow-up.
All patients achieved clinically relevant improvement (met minimal clinically important
differences (MCID)) on ASES, UCLA, and VAS with improved abduction strength restoration.
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Article info
Publication history
Accepted:
February 14,
2023
Received in revised form:
January 16,
2023
Received:
September 26,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Authors’ appointments and contributions:
Mingguang-Bi: Orthopaedic Surgeon
contributions: Designed the study, Acquired, analyzed and interpreted the data, Conducted the statistical analysis, Wrote the manuscript, Critically revised the manuscript
Wei-Ding: Orthopaedic Surgeon
contributions: Designed the study, Analyzed and interpreted the data, Conducted the statistical analysis
Minzhe-Zheng: Orthopaedic Surgeon
contributions: Designed the study, Acquired, analyzed and interpreted the data
Zhaoxiang-Peng: Orthopaedic Surgeon
contributions: Designed the study, Analyzed and interpreted the data
Jin-Lin: Orthopaedic Surgeon
contributions: Designed the study, Analyzed and interpreted the data
Shaohua-Ding: Orthopaedic Surgeon
contributions: Conceived and designed the study, Acquired, analyzed and interpreted the data, Wrote the manuscript, Critically revised the manuscript
Conflict of interest:
Mingguang-Bi1 MD;Wei-Ding1 MD;Minzhe-Zheng1 MD ; Zhaoxiang-Peng1 MD;Shaohua-Ding1 MD;Jin-Li1MD declare that they have no conflict of interest.
Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards
Informed consent: Informed consent was obtained from all individual participants included in the study.
Funding: Supported by the Key Medical Subject Program of Ningbo (No.2022-B01) and Ningbo medical science and technology program (2019Y03) and Municipal Natural Science Foundation of Ningbo City (202003N4278).
Level of Evidence: Retrospective case series, Level IV
Identification
Copyright
© 2023 Published by Elsevier on behalf of the Arthroscopy Association of North America
