Summary

The SCR with the distal fascia lata significantly improved clinical outcomes for patients with an irreparable rotator cuff tear with a 95% graft healing rate (63 in 66 shoulders). Angiogenesis inside the graft was observed in all patients at least 8 weeks after surgery.

Abstract

Introduction

Superior capsular reconstruction (SCR) with the fascia lata as a graft is an effective surgical option for irreparable rotator cuff tear. We have used the distal part of the fascia lata as a graft for SCR since 2013, considering its advantage of homogeneous thickness and the ease of harvesting and folding. The present study aimed to retrospectively assess our SCR for irreparable rotator cuff tears.

Materials And Methods

This study included 63 (mean age: 70.3 years old) patients who underwent SCR using fascia lata autograft from 2013 to 2023 and were followed up for at least 1 year (mean postoperative duration: 30.9 months; range: 12–113 months). All surgical procedures were performed under general anesthesia in the beach chair position. The defect size of the irreparable rotator cuff tear was measured after endoscopic observation of the glenohumeral joint and repair of the reparable rotator cuff tears using suture anchors. The fascia lata autograft, which was three times larger than the rotator cuff defect, was then harvested from the distal side of the greater trochanter and femoral condyle midpoint. The graft was folded two times (threefold) and then transported into the shoulder, and fixed to the upper glenoid rim with two suture anchors and the greater tuberosity with two or three suture anchors. The shoulders were immobilized for 5–6 weeks postoperatively using the abduction brace. Active assistive exercise was initiated at 5 weeks based on the kind of repaired rotator cuff. The results were assessed using the American Shoulder and Elbow Surgeons (ASES) score, active range of motion (ROM), and acromiohumeral interval (AHI) in X-ray at the final follow-up period. Graft integrity in magnetic resonance imaging (MRI) scans was evaluated using Hasegawa’s classification at 1 year postoperatively. The classification indicates graft healing in types 1–3, small graft tear in type 4, and large graft tear in type 5. Ultrasound power Doppler imaging was used to postoperatively observe angiogenesis inside the graft.

Results

The mean ASES score significantly increased from 40.5 points preoperatively to 91.8 points postoperatively (p < 0.01). Postoperative active ROMs were significantly increased compared with those preoperatively. The mean active ROMs preoperatively and postoperatively were 77.7° and 143.7° in flexion, 77.2° and 138.2° in abduction, 34.0° and 47.1° in external rotation, and the L3 and Th12 vertebral levels in internal rotation, respectively (all p < 0.01). The mean AHI increased from 6.9 mm preoperatively to 9.7 mm postoperatively (p < 0.01). Postoperative MRI scans indicated types 1, 2, 3, 4, and 5 in 34 (54%), 18 (29%), 8 (13%), 1 (2%), and 2 (3%) shoulders in Hasegawa’s classification, respectively. Angiogenesis into the graft was observed in 38%, 63%, and 100% of shoulders at 4, 6, and 8 weeks postoperatively, respectively.

Conclusion

The SCR with the distal fascia lata significantly improved clinical outcomes for patients with an irreparable rotator cuff tear with a 95% graft healing rate. Angiogenesis inside the graft was observed in all patients at least 8 weeks after surgery.