Denard, Arthroscopy 2017 - Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft

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Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft

Denard, Burkhart, et al.·Arthroscopy·2017·449 citations·Case series

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Purpose

The purpose of this study was to evaluate the short-term outcomes of arthroscopic superior capsule reconstruction (SCR) with dermal allograft for the treatment of irreparable massive rotator cuff tears (MRCTs).

Methods

A multicenter study was performed on patients undergoing arthroscopic SCR for irreparable MRCTs.
The minimum follow-up was 1 year.
Range of motion and functional outcome according to visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV) score were assessed preoperatively and at final follow-up.
Radiographs were used to evaluate the acromiohumeral interval (AHI).

Results

59 patients with a mean age of 62.0 years had a minimum follow-up of 1 year.
25 patients (42.4%) had a prior rotator cuff repair.
Forward flexion improved from 130 preoperative to 158 postoperative, and external rotation improved from 36 to 45, respectively (P < .001).
Compared with preoperative values, the VAS decreased from 5.8 to 1.7, the ASES score improved from 43.6 to 77.5, and the SSV score improved from 35.0 to 76.3 (P < .001).
The AHI was 6.6 mm at baseline and improved to 7.6 mm at 2 weeks postoperatively but decreased to 6.7 mm at final follow-up.
Based on postoperative magnetic resonance imaging, 45% (9 of 20) of the grafts demonstrated complete healing.
46 (74.6%) cases were considered a success.
11 patients (18.6%) underwent a revision procedure including 7 reverse shoulder arthroplasties.

Conclusions

Arthroscopic SCR using dermal allograft provides a successful outcome in approximately 70% of cases in an initial experience. The preliminary results are encouraging in this difficult to manage patient population, but precise indications are important and graft healing is low in our initial experience.

Level of evidence: Level IV, case series. Copyright remains with the authors and publisher.

Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft

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Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft

Denard, Burkhart, et al.·Arthroscopy·2017·449 citations·Case series

|

Purpose

The purpose of this study was to evaluate the short-term outcomes of arthroscopic superior capsule reconstruction (SCR) with dermal allograft for the treatment of irreparable massive rotator cuff tears (MRCTs).

Methods

A multicenter study was performed on patients undergoing arthroscopic SCR for irreparable MRCTs.
The minimum follow-up was 1 year.
Range of motion and functional outcome according to visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV) score were assessed preoperatively and at final follow-up.
Radiographs were used to evaluate the acromiohumeral interval (AHI).

Results

59 patients with a mean age of 62.0 years had a minimum follow-up of 1 year.
25 patients (42.4%) had a prior rotator cuff repair.
Forward flexion improved from 130 preoperative to 158 postoperative, and external rotation improved from 36 to 45, respectively (P < .001).
Compared with preoperative values, the VAS decreased from 5.8 to 1.7, the ASES score improved from 43.6 to 77.5, and the SSV score improved from 35.0 to 76.3 (P < .001).
The AHI was 6.6 mm at baseline and improved to 7.6 mm at 2 weeks postoperatively but decreased to 6.7 mm at final follow-up.
Based on postoperative magnetic resonance imaging, 45% (9 of 20) of the grafts demonstrated complete healing.
46 (74.6%) cases were considered a success.
11 patients (18.6%) underwent a revision procedure including 7 reverse shoulder arthroplasties.

Conclusions

Arthroscopic SCR using dermal allograft provides a successful outcome in approximately 70% of cases in an initial experience. The preliminary results are encouraging in this difficult to manage patient population, but precise indications are important and graft healing is low in our initial experience.

Level of evidence: Level IV, case series. Copyright remains with the authors and publisher.

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