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Mid-term outcome of superior capsular reconstruction using doubled acellular human dermal allograft for irreparable rotator cuff tear: An analysis of how graft thickness affects clinical outcome

Mid-term outcome of superior capsular reconstruction using doubled acellular human dermal allograft for irreparable rotator cuff tear: An analysis of how graft thickness affects clinical outcome

Priyadarshi Amit, MS, DNB, MRCSEd, MCh, FRCS, UNITED KINGDOM Abilash Hosahally Thimmegowda, MS(Orth), MRCS, MFSEM, FRCS,, UNITED KINGDOM Martyn Snow, FRCS, UNITED KINGDOM

The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UNITED KINGDOM


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Summary: Superior capsular reconstruction for irreparable posterosuperior rotator cuff tears with double folded dermal patch allograft results in improved clinical outcomes and low reoperation/complication rate over early to mid-term follow up duration.


Aim

The aim of this study was to evaluate the clinical outcome following superior capsular reconstruction (SCR) for irreparable posterosuperior rotator cuff tears using doubled (folded) acellular human dermis (HD) allograft over years follow up period.

Background

Massive rotator cuff tears with grade 4 Goutallier fatty infiltration are challenging conditions to treat and are associated with high re-tear rates and poor clinical outcome after attempted repair. Superior capsular reconstruction provides an alternative option with promising early treatment outcomes.

Methods

Patients who had undergone SCR using HD allograft of two thickness (2.5-3.5 mm ‘Standard’ and 4.5-5 mm ‘Thick’ graft) between February 2012 through July 2018 were recruited in a continuous manner in this retrospective study. The inclusion criteria were SCR performed for irreparable posterosuperior cuff tear after failed nonoperative treatment with postoperative follow up of minimum two years period. The primary outcome measure was American Shoulder and Elbow Surgeons (ASES) score. The secondary outcome measure was graft tear and reoperation rate.

Results

A total of 28 patients (28 shoulder joints) were analysed with mean follow up period of 48 months (range, 25-96 months). There were 12 males and 16 female patients. The mean age of the was 64 years (range, 47-81 years). Right shoulder (20 shoulders) was operated more often than left shoulder (8 shoulders). Subscapularis repair was performed in 13 (46.6%) shoulders and additional infraspinatus repair was performed in 15 (17.8%) shoulders. There was significant improvement in ASES score from preoperative value of 18.63 ± 15.06 to post-operative value of 76.71 ± 23.28 (P < 0.001) with satisfactory outcome obtained in 82.14% of patients. In a subset of eight patients completing five-years follow up, ASES score improved significantly from 21.22 ± 17.45 to 69.99 ± 29.21 with satisfactory outcome in 62.5% of patients. The patients with Thick grafts had significantly higher satisfactory outcome (93.33% vs 69.23%) than the patients with Standard grafts. Radiological graft failure was noted in 3 patients with Standard graft. One patient with Standard graft underwent revision to reverse shoulder arthroplasty.

Conclusions

Superior capsular reconstruction for irreparable posterosuperior rotator cuff tears with double folded dermal patch allograft results in improved clinical outcomes and low reoperation/complication rate over early to mid-term follow up duration. Thicker HD allografts may provide more consistent long term results compared to standard grafts.


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