CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(05): 876-883
DOI: 10.1055/s-0041-1732389
Artigo Original
Ombro e Cotovelo

Treatment of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction with Fascia Lata Allograft

Article in several languages: português | English
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
› Author Affiliations

Abstract

Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft.

Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI).

Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p = 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p = 0.001; p = 0.005; and p = 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p = 0.003; 30 to 60°, p = 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing.

Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Author's Contributions

Each author contributed individually and significantly to the development of the present article:


RAB: wrote the article; performed the surgeries; data collection; approved the final version.


MECG: wrote the article; performed the surgeries; follow-up of the patients; approved the final version.


EAM: statistical analysis; bibliographic review; approved the final version.


JHA: interpreted the results of the study; bibliographic review; clinical examination; approved the final version.


FBAS: data collection; survey of medical records; follow-up of the patients; approved the final version.


AAFN: participated in the review process; clinical examination; approved the final version.


* Work developed in the Shoulder and Elbow Group of the Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.




Publication History

Received: 21 October 2020

Accepted: 11 February 2021

Article published online:
11 November 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • Referências

  • 1 Yamamoto A, Takagishi K, Osawa T. et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010; 19 (01) 116-120
  • 2 Burks RT, Crim J, Brown N, Fink B, Greis PE. A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. Am J Sports Med 2009; 37 (04) 674-682
  • 3 McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen 3rd. FA. Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med 2015; 43 (02) 491-500
  • 4 Mihata T, Lee TQ, Watanabe C. et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy 2013; 29 (03) 459-470
  • 5 Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med 2012; 40 (10) 2248-2255
  • 6 Tokish JM, Beicker C. Superior capsule reconstruction technique using an acellular dermal allograft. Arthrosc Tech 2015; 4 (06) e833-e839
  • 7 Mihata T, Bui CNH, 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 (12) 2158-2166
  • 8 Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994; (304) 78-83
  • 9 Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 1990; (254) 92-96
  • 10 Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ. Biomechanical Effects of Acromioplasty on Superior Capsule Reconstruction for Irreparable Supraspinatus Tendon Tears. Am J Sports Med 2016; 44 (01) 191-197
  • 11 Gracitelli MEC, Beraldo RA, Malavolta EA, Assunção JH, Oliveira DRO, Ferreira Neto AA. Superior capsular reconstruction with fascia lata allograft for irreparable supraspinatus tendon tears. Rev Bras Ortop (Sao Paulo) 2019; 54 (05) 591-596
  • 12 Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 1986; 68 (08) 1136-1144
  • 13 Mihata T, Lee TQ. Clinical Outcomes of Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears without Osteoarthritis in the Glenohumeral Joint. Journal of Shoulder and Elbow Surgery 2015; 24 (04) e107-e109
  • 14 Mihata T, Lee TQ, Fukunishi K. et al. Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears. Am J Sports Med 2018; 46 (05) 1077-1083
  • 15 Pennington WT, Bartz BA, Pauli JM, Walker CE, Schmidt W. Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: short-term clinical outcomes and the radiographic parameter of superior capsular distance. Arthroscopy 2018; 34 (06) 1764-1773
  • 16 Burkhart SS, Hartzler RU. Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis. Arthroscopy 2019; 35 (01) 22-28
  • 17 Denard PJ, Brady PC, Adams CR, Tokish JM, Burkhart SS. Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft. Arthroscopy 2018; 34 (01) 93-99
  • 18 Hirahara AM, Andersen WJ, Panero AJ. Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up. Am J Orthop (Belle Mead NJ) 2017; 46 (06) 266-278
  • 19 Catapano M, de Sa D, Ekhtiari S, Lin A, Bedi A, Lesniak BP. Arthroscopic superior capsular reconstruction for massive, irreparable rotator cuff tears: a systematic review of modern literature. Arthroscopy 2019; 35 (04) 1243-1253
  • 20 Sochacki KR, McCulloch PC, Lintner DM, Harris JD. Superior capsular reconstruction for massive rotator cuff tear leads to significant improvement in range of motion and clinical outcomes: a systematic review. Arthroscopy 2019; 35 (04) 1269-1277
  • 21 Ekhtiari S, Adili AF, Memon M. et al. Sources, quality, and reported outcomes of superior capsular reconstruction: a systematic review. Curr Rev Musculoskelet Med 2019; 12 (02) 173-180
  • 22 Galvin JW, Kenney R, Curry EJ. et al. Superior capsular reconstruction for massive rotator cuff tears: a critical analysis review. JBJS Rev 2019; 7 (06) e1 ; 1–11
  • 23 Mihata T, Lee TQ, Hasegawa A. et al. Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears. Am J Sports Med 2018; 46 (11) 2707-2716
  • 24 Al Ramadhan H, Sungjoon L, In-Ho J. Early MRI findings of arthroscopic superior capsule reconstruction (ASCR): how to prevent early failure. Arthroscopy 2017; 33 (06 Suppl): e21
  • 25 Lee SJ, Min YK. 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 (07) 2205-2213
  • 26 Frank RM, Cvetanovich G, Savin D, Romeo AA. Superior capsular reconstruction: indications, techniques, and clinical outcomes. JBJS Rev 2018; 6 (07) e10 ;1–8