Summary

Arthroscopic superior capsule reconstruction using fascia lata autograft achieved high patient satisfaction and minor donor site morbidity, and patients could accept the minor donor site morbidity given the improvement in shoulder symptom, suggesting that the donor site morbidity is not an argument against the use of fascia lata autograft after arthroscopic superior capsule reconstruction.

Abstract

Introduction

Arthroscopic superior capsule reconstruction (SCR) using fascia lata (FL) autograft is a viable treatment option for irreparable rotator cuff tears (RCTs). To date, concerns regarding donor site morbidity potentially associated with autologous fascia lata harvesting is still an argument against FL autograft use. However, it remains unclear if the donor site morbidity affects the patient satisfaction after arthroscopic SCR. The objective of this study was to assess the donor site morbidity and patient satisfaction after arthroscopic SCR using FL autograft in patients with irreparable RCTs.

Methods

This prospective study enrolled consecutive patients with irreparable RCTs who underwent arthroscopic SCR from 2020 to 2022 and completed minimum 2-year follow-up. The FL autograft with the intermuscular septum was harvested from the ipsilateral thigh, and FL autografts of at least 6-mm thickness were prepared in all patients. After harvesting FL autograft, posterior fascia was sutured to the residual fibers of intermuscular sepum to reconstruct the femoral attachment of the gluteal major. American Shoulder and Elbow Surgeons (ASES) score and active shoulder range of motion (ROM) were assessed at the clinical visit of 2-year follow up. Postoperative graft integrity was also evaluated using magnetic resonance imaging at 2-year after surgery. Additionally, donor-site morbidity and patient satisfaction were assessed at 2-year follow-up by using the standardized subjective satisfaction questionnaires as previously described by Angelo et al. For the statistical analyses, Paired t-test or Wilcoxon signed-rank test was used to compare the preoperative and postoperative clinical outcome measures.

Results

Twenty-four patients (12 men and 12 women; mean age, 69.9 years; range, 51-84 years) were included in the study. The ASES score significantly improved preoperatively to postoperatively (45.7 to 86.5 points, P<0.0001). Active shoulder elevation and external rotation also significantly increased after surgery (P<0.0001, 0.02, respectively). The postoperative graft tear rate was 8.3% (2 of 24). There was no complication at the donor site such as hematoma, muscle hernia, and surgical site infection. The results of questionnaires about the donor site morbidity showed that 83.3% (20 of 24) patients reported that there was neither pain nor daily activity limitation, while 16.7% (4 of 24) patients reported they still had pain at the donor site but not affect activities. In terms of cosmetic satisfaction, 95.8% (23 of 24) patients reported that they were either “very satisfied,” “satisfied,” or “moderately satisfied,” while only 4.2% (1 of 24) of those was “moderately dissatisfied.” As for overall satisfaction, however, all patients reported that they were either “very satisfied,” “satisfied,” or “moderately satisfied.” None of the patients reported being either “very unsatisfied” or “unsatisfied.” Furthermore, all 24 patients answered yes to the question “Are the thigh symptoms compensated by the outcome obtained in the shoulder?”

Conclusion

Arthroscopic Superior capsule reconstruction using fascia lata autograft achieved high patient satisfaction and minor donor site morbidity. Our results revealed that patients could accept the minor donor site morbidity given the improvement in shoulder symptom. Therefore, donor site morbidity is not an argument against the use of FL autograft after arthroscopic SCR.