2019 ISAKOS Biennial Congress Paper #74
Biomechanical Effect of Superior Capsule Reconstruction Using a 3-mm and 6-mm Thick Acellular Dermal Patch Graft in a Dynamic Shoulder Model
Bastian Scheiderer, MD, Munich, Bavaria GERMANY
ELIFHO OBOPILWE, ME, BSc, Farmington, Connecticut UNITED STATES
Mark P. Cote, PT, DPT, MSCTR, Farmington, CT UNITED STATES
Florian B. Imhoff, MD, Priv.-Doz., Zurich SWITZERLAND
Felix Dyrna, MD, Münster GERMANY
Knut Beitzel, Prof. Dr., Cologne GERMANY
Andreas B. Imhoff, MD, Prof. Emeritus, Sauerlach / Munich, Bavaria GERMANY
Augustus D. Mazzocca, MS, MD, Waltham, MA UNITED STATES
Daichi Morikawa, MD, PhD, Tokyo JAPAN
Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, UNITED STATES
FDA Status Cleared
Summary
In a dynamic cadaveric shoulder model, SCR using a 6-mm thick acellular dermal allograft demonstrated superior glenohumeral stability results compared to a 3-mm thick acellular dermal allograft.
Abstract
Purpose
To evaluate the effect of superior capsule reconstruction (SCR) with a 3-mm and 6-mm thick acellular dermal allograft on shoulder biomechanics.
Methods
Eight fresh-frozen cadaveric shoulders were tested using a dynamic shoulder testing system. Maximum abduction angle (MAA), glenohumeral superior translation (ghST), subacromial peak contact pressure (sPCP) and cumulative deltoid force (cDF) were compared among 4 conditions: (1) intact shoulder, (2) simulated irreparable rotator cuff tear (RCT), (3) SCR using a 3-mm thick acellular dermal allograft, (4) SCR using a 6-mm thick acellular dermal allograft.
Results
A simulated irreparable RCT significantly decreased the MAA compared to the intact rotator cuff state (73% of intact; P < .001); significantly increased ghST (204% of intact; P = .001), sPCP (200% of intact; P < .001) and cDF (158% of intact; P < .001). SCR with a 3-mm thick patch significantly increased MAA (88% of intact; P = .01) and decreased ghST (138% of intact; P = .01) compared to the RCT state, but not sPCP (188% of intact) and cDF (141% of intact). SCR with a 6-mm thick patch significantly increased the MAA compared to the torn state (95% of intact; P < .001) and significantly decreased ghST (77% of intact; P < .001), sPCP (132% of intact; P < .001) and cDF (117% of intact; P = .001). There was no statistical difference in the MAA, ghST, sPCP and cDF when comparing SCR with a 6-mm thick patch to the intact rotator cuff state. GhST (P = .03), sPCP (P < .001) and cDF (P = .02) were significantly different when comparing SCR using a 3-mm thick patch to a 6-mm thick patch; MAA showed no difference.
Conclusion
SCR with a 3-mm thick acellular dermal allograft improved MAA and ghST in a simulated RCT. Moreover, SCR with a 6-mm thick graft instead of 3-mm thick graft decreased sPCP and cDF.
Clinical Relevance: SCR with a 6-mm thick acellular dermal allograft attached at 45° of shoulder abduction restores superior glenohumeral stability.