Graft tears after arthroscopic superior capsule reconstruction (ASCR): pattern of failure and its correlation with clinical outcome

• Published in: Archives of orthopaedic and trauma surgery 2019-02, Vol.139 (2), p.231-239
• Main Authors: Lim, Sungjoon, AlRamadhan, Hassan, Kwak, Jae-Man, Hong, Hanpyo, Jeon, In-Ho
• Format: Article
• Language: English
• Subjects: Arthroscopy - adverse effects; Arthroscopy - methods; Arthroscopy and Sports Medicine; Bioprosthesis - adverse effects; Clinical outcomes; Failure; Fascia Lata - transplantation; Female; Humans; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; NMR; Nuclear magnetic resonance; Orthopedics; Postoperative Complications - diagnosis; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - instrumentation; Reconstructive Surgical Procedures - methods; Rotator Cuff Injuries - diagnosis; Rotator Cuff Injuries - physiopathology; Rotator Cuff Injuries - surgery; Rupture - surgery; Shoulder Joint - diagnostic imaging; Shoulder Joint - surgery; Surgery; Transplantation, Autologous - adverse effects; Transplantation, Autologous - methods; Transplants - injuries; Treatment Outcome
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-018-3025-7

Introduction Arthroscopic superior capsule reconstruction (ASCR) using fascia lata autograft is a new surgical technique developed to overcome irreparable rotator cuff tears. There is little information about graft tear after ASCR and its impact on clinical outcome. This study is to investigate the graft tear rate, pattern of failure, and its correlation with clinical outcomes after arthroscopic superior capsule reconstruction (ASCR). Materials and methods From June 2013 to June 2016, 31 shoulders in 31 consecutive patients (mean 65.3 years) underwent ASCR using fascia lata autograft for irreparable large-to-massive tears. Magnetic resonance imaging (MRI) was performed before surgery and at mean 12.8 months (12–24 months) after surgery to assess fatty infiltration progression and graft integrity. Graft tear was defined as the loss of graft continuity and was categorized as medial and lateral rows according to the failure location. Acromiohumeral distance (AHD) was pre- and postoperatively measured with the standard radiograph. Pain visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, constant score, and physical examination were used to assess clinical outcomes. Average follow-up was 15 months (range 12–24 months) after surgery. Results Mean active forward elevation increased from 133° to 146° ( P  = 0.011). Mean VAS score, ASES score, and constant score significantly improved: from 6 to 2.5, 54.4 to 73.7, and 51.7 to 63.7, respectively ( P