2017 ISAKOS Biennial Congress ePoster #2221

 

Arthroscopic Fascial Patch Grafting Combined with Superior Capsular Reconstruction Using Long Head of Biceps for Irreparable Rotator Cuff Tears

Kazuhiko Kikugawa, MD, PhD, Aki-Gun, Hiroshima JAPAN
Mazda Hospital, Hiroshima, JAPAN

FDA Status Not Applicable

Summary

Arthroscopic fascial patch grafting combined with superior capsular reconstruction using LHB for irreparable rotator cuff tear restored superior glenohumeral instability and improved clinical outcome.

Abstract

Background

For irreparable rotator cuff tears, we have performed arthroscopic fascial patch grafting, but severe fatty muscle degeneration on preoperative MRI was associated with poor outcome and upward migration of humeral head. Mihata reported superior capsular reconstruction using fascia lata was reliable and useful treatment for irreparable rotator cuff tears. Therefore, from 2010, we performed arthroscopic fascial patch grafting combined with superior capsular reconstruction using long head of biceps (LHB). The purpose of this study is to evaluate the clinical outcomes of this new procedure.

Methods

From 2010 to 2013, 21 patient (male 12, female 9, mean age: 66.9 years) with irreparable rotator cuff tears (large 5, massive 16) were treated by this procedure. Mean follow-up was 32.6 months (18-58 months). LHB was transferred posterior and attached to the greater tuberosity using suture anchors for superior capsular reconstruction. The size of fascia lata patch is almost equal size of defect. Between Proximal side of patch and supraspinatous and infraspinatous tendon was mattress sutured. Distal side of patch was repaired by 6 single row, 3 dual row and 10 suture bridge technique. Clinical results were evaluated according to American Shoulder and Elbow Surgeons (ASES) score and Constant score. Acromiohumeral distance (AHD) and osteoarthritis were evaluated by radiography and cuff integrity and re-tear was evaluated by MRI.

Results

The mean ASES score improved from 41.1 to 85.1 points. The mean Constant score improved from 36.4 to 82.1 points. 7 cases had poor outcomes causing limitation of range of motion in 5 cases and loss of muscle strength in 7cases. Re-tear of rotator cuff and graft tear observed by MRI were 6 cases. There is no cases had progression of osteoarthritis. AHD increased from 3.5mm preoperatively to 7.6mm postoperatively. 6 cases with re-tear and upward migration of humeral head had LHB dislocation by subscapular tear.

Conclusions

Arthroscopic fascial patch grafting combined with superior capsular reconstruction using LHB for irreparable rotator cuff tear restored superior glenohumeral instability and improved clinical outcome. This procedure was new useful treatment for irreparable rotator cuff tears.