Summary

Superior capsule reconstruction (SCR) using fascia lata autograft regenerated fibrocartilaginous insertion at both the greater tuberosity and superior glenoid. The mid-substance of the grafted fascia gradually remodeled into tendon/ligament-like tissue. These results suggest that the fascia lata autograft has the capacity for graft-to-bone healing and remodeling after SCR.

Abstract

Background

Superior capsule reconstruction (SCR) has been developed to improve shoulder function and relieve pain in the treatment of irreparable rotator cuff tears. Previous studies have reported that graft healing can enhance favorable outcomes after SCR. On the other hand, the graft tear leads to less desirable outcomes and sometimes requires additional surgeries. However, the healing process underlying this remains unclear. In this study, we aimed to investigate histological changes occurring during the healing process associated with autologous fascia lata graft after SCR in vivo. We hypothesized that 1) autologous fascia lata graft can regenerate fibrocartilaginous insertion into both the greater tuberosity and superior glenoid and 2) the mid-substance of the grafted fascia gradually remodels into tendon/ligament-like tissue after SCR.

Methods

Irreparable supraspinatus tears were created in 24 mature Japanese white rabbits (age, 6 months; mean weight, 3.2 kg). Four weeks after creating the defects, the right shoulders were subjected to SCR using autologous fascia lata grafts. The left shoulders were left untreated. Samples from the shoulders were harvested at 4, 8, 12, and 16 weeks after surgery to perform histological examinations and immunohistochemistry.

Results

Macroscopically, we did not observe graft tear after SCR in our experiments. Histologically, chondrocyte-like cells gradually increased and the extracellular matrices around those cells contained glycosaminoglycan at the fascia-bone junction after SCR. The unmineralized fibrocartilage, mineralized fibrocartilage, and tidemark were observed at 16 weeks after SCR. The distribution of type II collagen presented a pattern similar to that of a normal tendon and ligament insertion. In the mid-substance of the grafted fascia, disorganized collagen fibers were observed 4 weeks after SCR.
At 12 and 16 weeks after surgery, the arrangement of cells and the orientation of collagen fibers were found to be parallel to the long axis. These results suggest that the mid-substance of the grafted fascia gradually remodeled into tendon/ligament-like tissue.
Regarding the vascularity, blood vessels were observed in the mid-substance of the grafted fascia lata at all postoperative time points.

Conclusions

SCR using fascia lata autograft regenerated fibrocartilaginous insertion at both the greater tuberosity and superior glenoid. The mid-substance of the grafted fascia gradually remodeled into tendon/ligament-like tissue. These results suggest that the fascia lata autograft has the capacity for graft-to-bone healing and remodeling after SCR.