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Is Donor Site Morbidity A Valid Argument Against The Use Of Autologous Fascia Lata In Arthroscopic Superior Capsular Reconstruction? A Mid-Term Follow-Up Evaluation Of 53 Patients.

Is Donor Site Morbidity A Valid Argument Against The Use Of Autologous Fascia Lata In Arthroscopic Superior Capsular Reconstruction? A Mid-Term Follow-Up Evaluation Of 53 Patients.

Ana Catarina Ângelo 515904945, MD, PORTUGAL Clara Azevedo, MD, PhD, PORTUGAL

Centro Hospitalar de Lisboa Ocidental, Lisboa, Lisboa, PORTUGAL


2021 Congress   Abstract Presentation   4 minutes   Not yet rated

 

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Summary: Donor site morbidity (DSM) is a recurrent argument against the use of autologous fascia lata (AFL) in arthroscopic superior capsular reconstruction (ASCR). 53 patients who underwent ASCR using a minimally invasively harvested AFL were retrospectively reviewed regarding donor site function and subjective satisfaction. DSM was not significant when compared with standard values.


Background

The use of autologous fascia lata (AFL) in arthroscopic superior capsular reconstruction (ASCR) has been shown to be effective for the treatment of irreparable rotator cuff tears. However, donor site morbidity (DSM) is a recurrent argument against the use of this graft, despite the scarce scientific-based evidence to support it. Based on this premise, several alternative types of graft have been suggested for ASCR, but so far no other graft has matched the results obtained in the shoulder using AFL with regard to patient-reported outcomes, range of motion, graft survivorship, and revision rate. This study aimed to report the clinical mid-term follow-up (FU) evaluation of DSM in patients who underwent ASCR using the minimally invasively harvested AFL graft. It was hypothesized that the DSM produced by the minimally invasive AFL harvesting technique would not be significant and would be compensated by the shoulder outcome.

Methods

Sixty-five consecutive patients who underwent ASCR using the minimally invasively harvested AFL between 2015 and 2021 by the same surgical team were retrospectively reviewed. Patients who had less than 6 months of FU, suffered subsequent injuries to either of the lower limbs or had died, were excluded. The functional outcome of the harvested and contralateral thighs was evaluated using the WOMAC score. Patient satisfaction was evaluated using the Patient Scar Assessment Questionnaire (PSAQ), and a subjective dichotomous questionnaire. Pain was assessed using the Visual Analogue Scale (VAS). The paired samples T-test was used to compare outcome and satisfaction scores. Pearson’s chi-square test was used to compare the categorical variables, and Pearson’s correlation and linear regression were used to analyze the continuous variables. Statistical significance level was set at p<.05.

Results

Fifty-four patients met the inclusion criteria, 1 was lost to FU. 53 patients were enrolled (34% male, 66% female; average age, 65.5 ± 7.16 years). The mean FU was 38.3 ± 18.9 months, and 75% of the patients had more than 21.5 months of FU (percentile, 25). The mean WOMAC Score significantly differed by 1% between the harvested and unharvested thighs (p<.001). The mean PSAQ score in the harvested thigh significantly differed by 5% from the minimum PSAQ value (p<.001). 30.2% of the patients reported residual thigh symptoms. 92.5% of the patients considered that the thigh symptoms were compensated by the shoulder outcome and would agree to undergo the same procedure again. The female gender correlated with a lower WOMAC of the harvested thigh (p=.009) and with a positive answer to the question: does the harvested thigh bother you? (p=.03). WOMAC of the harvested thigh was significantly lower in patients with donor site residual symptoms (p=.009) and, of the specified symptoms, only pain was statistically significant (p<.001). Mean VAS was 0.9 (range, 0–5).

Conclusion

At a mid-term FU, the minimally invasive AFL harvesting technique does not produce significant functional or subjective morbidity and the residual thigh symptoms are compensated by the shoulder outcome. DSM does not seem to be a valid argument against the use of AFL in ASCR.


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