Summary

Three-portal arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft in 35 consecutive patients with irreparable rotator cuff tears (IRCTs) who had a mean follow-up of 19 months±8.1 months (range: 6–36 months) produced good shoulder outcomes with a subjectively non-significant thigh morbidity.

Abstract

Background

Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs) in active patients are a challenge. Arthroscopic superior capsular reconstruction (ASCR) is a new treatment option that was originally described using a fascia lata autograft harvested through an open approach. However, concerns about donor site morbidity discouraged surgeons from using this type of graft.

Hypothesis

ASCR using a fascia lata autograft harvested through a minimally invasive approach produces good shoulder outcomes and a non-significant thigh morbidity in IRCTs.
Study Design: Case series study; level of evidence: 4.

Methods

A retrospective review was conducted using the prospectively collected data of a total of thirty-nine consecutive patients with IRCTs who underwent three-portal ASCR using a minimally invasive harvested fascia lata autograft from 2015 to 2018, by the same surgeon (first author). 4/39 patients with a postoperative follow-up of less than 6 months were excluded. Thirty-five consecutive patients, with a mean postoperative follow-up of 19 months±8.1 months (range: 6–36 months) were included in this study. The patients had a mean age of 65.3 years±7.7 years and a chronic IRCT with a mean duration of symptoms before surgery of 31 months±45.2 months. The patients were Hamada grade 1 (twenty-two patients) or 2 (thirteen patients), with a Goutallier cumulative score > 3. Three patients were Patte stage 1, eleven patients were Patte stage 2, and twenty-one patients were Patte stage 3. All patients completed the preoperative and postoperative evaluations: simple shoulder test (SST), subjective shoulder value (SSV), constant score (CS), range of motion (ROM), radiological acromiohumeral interval (AHI) and donor site morbidity assessments. Thirty-four patients (34/35) underwent a preoperative shoulder magnetic resonance imaging (MRI) and one patient (1/35) underwent a preoperative shoulder computed tomography (CT) scan assessment. At final follow-up, twenty-nine patients had an MRI and one patient had a CT scan available for analysis of the graft integrity (30/35). IBM SPSS Statistics 23 software was used for the statistical analysis (paired-samples t-test; Mann-Whitney U test; Fisher’s exact test). A significant difference was defined as P<0.05 (confidence interval of 95%).

Results

The mean active ROMs improved significantly at final follow-up (p<0.001): elevation, 71.6º±55.5º to 144.9º±30.1º; abduction, 56.3º±44.2º to 119.7º±38.3º; external rotation, 14.4º±17.3º to 36.1º±15.7º; internal rotation, 1.2±1.6 to 3.7±1.4 points. The mean functional shoulder scores improved significantly (p<0.001): SST, 2.1±2.9 to 8.7±3.3; SSV, 31.7±22.3% to 69.7±22.1%; CS, 18.2±15.1 to 64.7±19.0. The mean shoulder abduction strength improved significantly (p<0.001): from 0kg to 2.6±2.5kg. The mean AHI improved from 6.6±2.9mm to 7.4±2.7mm. 3/30 patients (10%) had a graft tear. At final follow-up, 14/35 patients (40%) were bothered by their harvested thigh; 25/35 patients (71.4%) noticed donor site changes: deformity (6/35, 17.1%), pain (13/35; 37.1%), numbness (15/35; 42.9%) or donor site-related claudication (2/35; 5.7%); 25/30 patients (83.3%) considered that the shoulder surgery’s end result compensated for the thigh’s changes and 27/32 patients (84.4%) would undergo the same surgery again.

Conclusion

Three-portal ASCR using a minimally invasive harvested fascia lata autograft produced good shoulder outcomes with a subjectively non-significant thigh morbidity in IRCTs.