Arthroscopic superior capsular reconstruction with acellular human dermal allograft for irreparable rotator cuff tears: outcomes, complications, and reoperations at 2-year minimum follow-up.
Academic Article
Overview
abstract
BACKGROUND: Management of posterosuperior irreparable rotator cuff tears (IRCTs) remains challenging without clear consensus among shoulder surgeons. Arthroscopic superior capsular reconstruction (SCR) with dermal allograft has been proposed as a promising treatment option. However, current investigations are limited to short term studies and recent data has suggested variable clinical outcomes. Therefore, the purpose of this investigation was to report intermediate-term clinical outcomes in patients who underwent arthroscopic SCR with a dermal allograft for IRCTs. METHODS: Over a 4-year period (2016-2020), all patients who underwent an arthroscopic dermal allograft SCR with a minimum 2-year follow-up period were identified. SCR with dermal allograft was performed for patients with an IRCT utilizing a 3-mm acellular dermal allograft. Collected clinical outcomes included range of motion, strength, Numeric Rating Scale for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Single-Assessment Numeric Evaluation score, complications, and reoperations. RESULTS: The final cohort included 41 dermal allograft SCR performed in 40 patients (1 bilateral) with a majority male cohort (n = 29; 72%), a mean age of 67 ± 7 years, body mass index of 28.4 ± 5.0, and follow-up of 5.3 ± 1.4 years. Clinically, there was a significant improvement in preoperative and postoperative Numeric Rating Scale pain scores from 5.0 to 1.8 (P < .001), but no differences in preoperative and postoperative forward flexion (P = .268), abduction (P = .822), external rotation (P = .323), or internal rotation (P = .995). The final postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form and Single-Assessment Numeric Evaluation scores were 66 ± 28 and 59 ± 30, respectively. There were 8 (19.5%) complications, which consisted primarily of symptomatic graft failure in 6 (14.6%) shoulders and progression of rotator cuff arthropathy in 2 (4.9%) shoulders. Reoperations occurred in 6 (14.3%) shoulders: 4 (9.8%) were conversion to reverse total shoulder arthroplasty and 2 (4.9%) were arthroscopic revision dermal allograft SCR with partial repair and reattachment of the torn graft. CONCLUSION: At a cohort mean of 5 years after arthroscopic SCR with dermal allograft for IRCTs, patients experienced sustained pain relief but no significant improvement in shoulder function. Additionally, 20% sustained a postoperative complication with a 14% reoperation rate. These findings should be considered when counseling patients about the challenges of managing IRCTs and the possible outcomes of utilizing dermal allograft SCR as a surgical modality.
