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Graft Healing Is More Important Than Graft Technique: Superior Capsular Reconstruction Versus Bridging Grafts—A Prospective Randomized Controlled Trial

Open AccessPublished:July 11, 2022DOI:https://doi.org/10.1016/j.arthro.2022.06.033

      Purpose

      To compare superior capsular reconstruction (SCR) versus bridging graft (BG) for massive irreparable rotator cuff tears (RCTs).

      Methods

      A prospective double-blind randomized study was conducted to compare SCR versus BG for massive irreparable RCTs. Fifty patients (mean age: 60.2 ± 6.0 years) with chronic tears (mean duration of symptoms: 5 ± 5.2 years) were intraoperatively randomized following partial repair to SCR or BG using human dermal allograft. All patients underwent standardized rehabilitation and were followed at 3, 6, 12, and 24 months clinically and radiographically. Magnetic resonance imaging were obtained at 12 months to determine graft integrity.

      Results

      At 2 years, 46 patients were available for follow-up. Mean American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff (WORC), and Quick Disabilities of the Arm, Shoulder and Hand scores were 74.8 ± 23.9, 66.0 ± 28.3, and 24.7 ± 26.1 for the SCR group, and 77.9 ± 19.9, 69.5 ± 24.5, and 25.0 ± 19.1 for the BG group, respectively, with no significant difference between groups. Magnetic resonance imaging demonstrated 18 of 24 (75%) in the SCR group and 14 of 22 (64%) in the BG group were intact at 12 months (P = .53). Patients with intact grafts compared with those with retorn grafts, whether SCR or BG, had greater ASES and WORC scores at 24 months (ASES 81.0 ± 18.7 vs 65.7 ± 24.4, P = .021 and WORC 72.3 ± 24.6 vs 53.7 ± 26.7, P = .04) and greater acromiohumeral intervals on radiographs at all follow-up time points.

      Conclusions

      When performing arthroscopic reconstruction using human dermal allograft for an irreparable RCT, whether the proximal edge of the graft is attached on the glenoid bone or to the torn tendon does not significantly change short-term clinical and radiographic outcomes.

      Level of Evidence

      I, therapeutic.
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      References

        • Anley C.M.
        • Chan S.K.
        • Snow M.
        Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder.
        World J Orthop. 2014; 5: 557-565
        • Barber F.A.
        • Burns J.P.
        • Deutsch A.
        • Labbe M.R.
        • Litchfield R.B.
        A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair.
        Arthroscopy. 2012; 28: 8-15
        • Gupta A.K.
        • Hug K.
        • Berkoff D.J.
        • et al.
        Dermal tissue allograft for the repair of massive irreparable rotator cuff tears.
        Am J Sports Med. 2012; 40: 141-147
        • Kovacevic D.
        • Suriani Jr., R.J.
        • Grawe B.M.
        • et al.
        Management of irreparable massive rotator cuff tears: A systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response.
        J Shoulder Elbow Surg. 2020; 2: 2459-2475
        • Wong I.
        • Burns J.
        • Snyder S.
        Arthroscopic GraftJacket repair of rotator cuff tears.
        J Shoulder Elbow Surg. 2010; 19 (2 suppl).: 104-109
        • Lewington M.R.
        • Ferguson D.P.
        • Smith T.D.
        • Burks R.
        • Coady C.
        • Wong I.H.
        Graft utilization in the bridging reconstruction of irreparable rotator cuff tears: A systematic review.
        Am J Sports Med. 2017; 45: 3149-3157
        • Ricchetti E.T.
        • Aurora A.
        • Iannotti J.P.
        • Derwin K.A.
        Scaffold devices for rotator cuff repair.
        J Shoulder Elbow Surg. 2012; 21: 251-265
        • Ono Y.
        • Dávalos Herrera D.A.
        • Woodmass J.M.
        • Boorman R.S.
        • Thornton G.M.
        • Lo I.K.Y.
        Healing rate and clinical outcomes of xenografts appear to be inferior when compared to other graft material in rotator cuff repair: A meta-analysis.
        J ISAKOS. 2016; 1: 321-328
        • Mihata T.
        • Lee T.Q.
        • Watanabe C.
        • et al.
        Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
        Arthroscopy. 2013; 29: 459-470
        • Mihata T.
        • McGarry M.H.
        • Pirolo J.M.
        • Kinoshita M.
        • Lee T.Q.
        Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: A biomechanical cadaveric study.
        Am J Sports Med. 2012; 40: 2248-2255
        • Woodmass J.M.
        • Wagner E.R.
        • Borque K.A.
        • Chang M.J.
        • Welp K.M.
        • Warner J.P.
        Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
        J Shoulder Elbow Surg. 2019; 28: S100-S109
        • Gerber C.
        • Fuchs Hodler J.
        The results of repair of massive tears of the rotator cuff.
        J Bone Joint Surg Am. 2000; 82: 505-515
        • DeOrio J.K.
        • Cofield R.H.
        Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.
        J Bone Joint Surg Am. 1984; 66: 563-567
        • Michener L.A.
        • McClure P.W.
        • Sennet B.J.
        American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness.
        J Shoulder Elbow Surg. 2002; 11: 587-594
        • de Witte P.
        • Henseler J.
        • Nagels J.
        • Vliet Vieland T.
        Neilssen R The Western Ontario rotator cuff index in rotator cuff disease patients: A comprehensive reliability and responsiveness validation study.
        Am J Sports Med. 2021; 40: 1611-1619
        • Gummesson C.
        • Ward M.
        • Atroshi I.
        The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): Validity and reliability based on responses within the full-length DASH.
        BMC Musculoskelet Disord. 2006; 18: 44
        • Burkhart S.
        • Denard P.
        • Adams C.
        • Brady P.
        • Hartzler R.
        Arthroscopic SCR reconstruction for massive irreparable rotator cuff repair.
        Arthrosc Tech. 2016; 5: 1407-1418
        • Tashjian R.Z.
        • Deloach J.
        • Green A.
        • Porucznik C.A.
        • Powell A.P.
        Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease.
        J Bone Joint Surg Am. 2010; 92: 296-303
        • Doig G.S.
        • Simpson F.
        Randomization and allocation concealment: A practical guide for researchers.
        J Crit Care. 2005; 20 (; discussion 191-193): 187-191
        • Burkhart S.S.
        • Nottage W.M.
        • Ogilvie-Harris D.J.
        • Kohn H.S.
        • Pachelli A.
        Partial repair of irreparable rotator cuff tears.
        Arthroscopy. 1994; 10: 363-370
        • Greiner S.
        • Kaeaeb M.
        • Voss A.
        • Lawton R.
        • Bhide P.
        • Achenbach L.
        Comparison of superior capsular reconstruction and partial infraspinatus repair: A matched-pair analysis of irreparable rotator cuff tears.
        Orthop J Sports Med. 2021; 9
        • Thomas K.
        • Kendal J.K.
        • Ono Y.
        • Lo I.K.Y.
        • Bois A.J.
        The role of partial rotator cuff repairs in patients with massive irreparable tears without arthritis.
        Orthopedics. 2020; 43: e1-e7
        • Mihata T.
        • Lee T.Q.
        • Hasegawa A.
        • et al.
        Arthroscopic superior capsule reconstruction for irreparable rotator cuff tears: Comparison of clinical outcomes with and without subscapularis tear.
        Am J Sports Med. 2020; 48: 3429-3438
        • Lee S.J.
        • Min Y.K.
        Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2205-2213
        • Abd Elrahman A.A.
        • Sobhy M.H.
        • Abdelazim H.
        • Omar Haroun H.K.
        Superior capsular reconstruction: Fascia lata versus acellular dermal allograft: A systematic review.
        Arthrosc Sports Med Rehabil. 2020; 2: e389-e397
        • Mihata T.
        • Bui C.N.H.
        • Akeda M.
        • et al.
        A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear.
        J Shoulder Elbow Surg. 2017; 26: 2158-2166
        • Mihata T.
        • McGarry M.H.
        • Kahn T.
        • Goldberg I.
        • Neo M.
        • Lee T.Q.
        Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus Tears.
        Arthroscopy. 2016; 32: 418-426
        • Cline K.E.
        • Tibone J.E.
        • Ihn H.
        • et al.
        Superior capsule reconstruction using fascia lata allograft compared with double- and single-layer dermal allograft: A biomechanical study.
        Arthroscopy. 2021; 37: 1117-1125
        • Denard P.J.
        • Brady P.C.
        • Adams C.R.
        • Tokish J.M.
        • Burkhart S.S.
        Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft.
        Arthroscopy. 2018; 34: 93-99
        • Gila R.
        • Haunschild E.D.
        • Williams B.T.
        • et al.
        Patient factors associated with clinical failure following arthroscopic superior capsular reconstruction.
        Arthroscopy. 2021; 37: 460-467
        • Mihata T.
        • Lee T.Q.
        • Hasegawa A.
        • et al.
        Five-year follow-up of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
        J Bone Joint Surg Am. 2019; 101: 1921-1930
        • Azevedo C.I.C.
        • Catarina Leiria Pires Gago Angelo A.
        • Campos-Correia D.
        • Delgado L.
        • Ferreira N.
        • Sevivas N.
        Clinical importance of graft integrity in arthroscopic superior capsular reconstruction using a minimally invasively harvested midthigh fascia lata autograft: 3-year clinical and magnetic resonance imaging outcomes.
        Am J Sports Med. 2020; 48: 2115-2128
        • Ono Y.
        • Davalos Herrera D.A.
        • Woodmass J.M.
        • Boorman R.S.
        • Thornton G.M.
        • Lo I.K.
        Graft augmentation versus bridging for large to massive rotator cuff tears: A systematic review.
        Arthroscopy. 2017; 33: 673-680
        • Awad M.A.
        • Sparavalo S.
        • Ma J.
        • King J.P.
        • Wong I.
        Interposition graft bridging reconstruction of irreparable rotator cuff tears using acellular dermal matrix: Medium-term results.
        Arthrsocopy. 2021; : 0749-8063