2017 ISAKOS Biennial Congress ePoster #2220

 

Arthroscopic Superior Capsular Reconstruction with Minimally Invasive Harvesting of Autologous Fascia Lata for Complete Rotator Cuff Tears: Better Outcomes at Early Milestones?

Clara Azevedo, MD, Lisbon PORTUGAL
Catarina Ângelo, MD, Lisbon PORTUGAL
Susana Vinga, PhD, Lisboa PORTUGAL
Luis Sobral, MD, Lisboa PORTUGAL

Centro Hospitalar de Lisboa Ocidental; GIGA, Grupo Integrado de Gestão de Acidentes; Hospital dos SAMS, Lisboa, PORTUGAL

FDA Status Not Applicable

Summary

Arthroscopic Superior Capsular Reconstruction does not provide better clinical or functional outcomes than isolated arthroscopic rotator cuff repair at 6 months postoperative, however it achieves equivalent outcomes and a higher increase in acromiohumeral distance even in more retracted and long-standing rotator cuff tears.

Abstract

Arthroscopic superior capsular reconstruction (ASCR) is a treatment option for irreparable complete rotator cuff tendon tears. The remaining rotator cuff is preferentially incorporated in the final repair. It can also be considered as an augmentation procedure for repairable complete rotator cuff tears, theoretically offering biomechanical and biological advantages over isolated rotator cuff repair, which has high retear and poor healing rates. We hypothesized that ASCR patients could have better outcomes than isolated arthroscopic rotator cuff repair patients at early follow-up (6 months).
15 consecutive patients with irreparable rotator cuff tears underwent ASCR, with minimally invasive harvesting of autologous fascia lata, during a period of 8 months (group 1). The preoperative and 6 months postoperative clinical, functional, radiological and MRI shoulder outcomes were compared with a group of 11 patients with complete rotator cuff tears that underwent arthroscopic repair (group 2). The donor site of ASCR patients was evaluated at 6 months using the Non-Arthritic Hip Score (NAHS). Statistical analysis and group comparison: IBM SPSS® Statistics 22 (fisher exact test; Mann-Whitney U test). Significance level set to 0.05.
No statistical differences were found between the two groups considering: gender (male/female: group 1=6/9; group 2=4/7), age (mean: group 1=64.6 years; group 2=59.5 years), hand dominance, side, work compensation, previously failed rotator cuff repair (5 patients in group 1 had previously failed rotator cuff repair=33.3%; 2 patients in group 2=18.2%), preoperative and postoperative clinical and functional shoulder evaluation (painless shoulder active range of motion, Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), Constant score (mean increase of 25 for both groups), Hamada radiological shoulder arthropaty classification, number and type of rotator cuff tendons teared and repaired (mean number of tendons teared: 2.3 in group 1 and 2 tendons in group 2; 46.6% of patients in group 1 and 54.5% in group 2 had subcapularis tendon repair), number of sutures (p=0,053) and number of anchors used on the rotator cuff, long head of the biceps associated procedure, preoperative and 6 months postoperative radiological acromiohumeral distance.
Statistical differences were found considering: time elapsed until surgical treatment (mean: group 1=27.4 months; group 2=2.8 months;p=0.002), Patte classification of tendon retraction on MRI (66.7% of group 1 tears were grade 3 and 63.6% of tears in group 2 were grade 2; p=0,008), complications at 6 months postoperative (group 1 had one case of infection=6.6% infection rate; group 2 had one case of capsulitis, and 7 partial or complete retears on MRI=63.6% retear rate, two patients warranted revision surgery;p=0,001), mean increase of acromiohumeral distance at 6 months postoperative (group 1 had a higher mean increase in acromiohumeral distance than group 2: 2.2mm versus 0.5mm; p=0.036).
Medium NAHS for ASCR patients was 90 in the donor thigh and 99 in the contralateral thigh (medium negative variation=9 points;p=0.001).
Arthroscopic Superior Capsular Reconstruction does not provide better clinical or functional outcomes than isolated arthroscopic rotator cuff repair at 6 months postoperative, however it achieves equivalent outcomes and a higher increase in acromiohumeral distance even in more retracted and long-standing rotator cuff tears.