Summary

Postoperative graft thickness and size of graft tear affected clinical and radiographic outcomes after superior capsule reconstruction using a fascia lata autograft. Shoulders with intact grafts of sufficient thickness restored glenohumeral stability and showed better clinical outcomes compared to those with graft thinning or graft tears.

Abstract

Background

Previous studies have postulated that graft thickness and graft healing may be important factors for optimizing clinical outcomes of superior capsule reconstruction (SCR) for patients with irreparable rotator cuff tears (RCTs). However, the relationship between postoperative graft integrity and clinical outcomes after SCR remains unclear. We aimed to assess the relationship between postoperative graft integrity, including graft thickness and size of graft tear, and clinical outcomes after SCR in patients with irreparable RCTs.

Methods

This retrospective multicenter study included 188 patients (86 women, 102 men; mean age, 69.2 years; range, 49–87 years) with irreparable RCTs who underwent arthroscopic SCR using fascia lata autografts. Postoperative graft integrity was evaluated using magnetic resonance imaging (MRI) at 1 year or later after surgery and was classified into four categories according to Hasegawa’s classification: type I-II, intact graft of sufficient thickness; type III, thinned graft without discontinuity; type IV, presence of a minor discontinuity; and type V, presence of a major discontinuity. We compared (1) baseline characteristics, (2) visual analog scale (VAS) for pain, (3) American Shoulder and Elbow Surgeons (ASES) score, (4) active shoulder range of motion (ROM), and (5) acromiohumeral distance (AHD) among four groups based on postoperative graft integrity.

Results

MRI scans revealed 152 shoulders (80.9%) with type I-II graft, 13 (6.9%) with type III graft, 13 (6.9%) with type IV graft, and 10 (5.3%) with type V graft. VAS and ASES scores significantly improved after SCR in all graft types (all P<0.05). However, shoulders with type V grafts had significantly inferior postoperative VAS and ASES scores compared to those with type I-II grafts (all P<0.05). Shoulders without graft tears (types I-II and III) showed significant improvements in shoulder ROM after SCR (all P<0.05). In contrast, shoulders with large graft tears (types V) showed no significant improvement in shoulder ROM. Postoperative AHD was significantly increased only in shoulders with type I-II grafts (both P<0.0001).

Conclusion

Postoperative graft thickness and size of graft tear affected clinical and radiographic outcomes after SCR using a fascia lata autograft. Patients with large graft tears had significantly inferior postoperative clinical scores compared to those with intact grafts of sufficient thickness although arthroscopic SCR provided pain relief even in patients with graft tears. Shoulders with intact grafts of sufficient thickness restored glenohumeral stability and showed better clinical outcomes compared to those with graft thinning or graft tears.