Summary

Arthrocopic SCR performed using a doubled layered dermal allograft resulted in good clinical improvements in the short to midterm in patients with irreparable rotator cuff tears.

Abstract

Superior Capsule Reconstruction (SCR) has gained popularity for the treatment of irreparable rotator cuff tear. The inventor of the procedure has reported excellent results with the use of autologous facia lata. However, the use of dermal allografts has proved preferable by the majority of surgeons in order to reduce surgical time and donor morbidity. Currently there is a paucity of literature available on the outcome of dermal allograft for SCR.

Aim

To assess the 1-5years results of superior capsule reconstruction (SCR) using doubled dermal allograft.

Method

45 consecutive patients who underwent SCR for irreparable rotator cuff repair were assessed clinically. The surgery was performed all arthroscopically by a single surgeon using a doubled layer dermal allograft (Graftjacket). Fixation was undertaken using 2 glenoid anchors and 4 humeral anchors. The subscpularis was intact or repaired in all patients. Similarly, infraspinatus was intact or repaired in all patients. Clinical outcome was assessed using the American Shoulder and Elbow Score and the Western Ontario Rotator Cuff score pre-surgery and at final follow-up. Complications were recorded and the need for revision surgery.

Results

The surgical population consisted of 23 males and 22 females with a mean age of 65years (55-72). The mean follow-up was 24months (1-5yrs). The mean pre-operative ASES and WORC score were 22.5 and 25.5 respectively. At final follow-up, the ASES and WORC scores were 82 and 78. There were 2 failures, a 63yr patient following previous failed rotator cuff tear failed clinically at 6 months and underwent a reverse shoulder replacement at 12months. A second patient failed clinically at 2 years post SCR following an initial good result. A MRI scan demonstrated graft failure on the glenoid side. 1 patient experience temporary stiffness that improved with physiotherapy. No further complications were reported.

Conclusion

Arthrocopic SCR performed using a doubled layered dermal allograft resulted in good clinical improvements in the short to midterm in patients with irreparable rotator cuff tears. The clinical failure rate was 4% with a low complication rate. Graft integrity was not imaged in all patients and consequently maybe significantly higher than the clinical failure rate.