Arthroscopic Superior Capsular Reconstruction With Acellular Porcine Dermal Xenograft for the Treatment of Massive Irreparable Rotator Cuff Tears

Martin Polacek, Martin Polacek

Abstract

Purpose: To evaluate the short-term clinical outcomes and the complications related to arthroscopic superior capsular reconstruction (SCR) with acellular porcine dermal xenograft for the treatment of irreparable massive rotator cuff tears.

Methods: A prospective observational study of patients treated with arthroscopic SCR for irreparable massive rotator cuff tears in the period from 2016 to 2017 was performed. Range of motion and Shoulder Pain and Disability Index (SPADI) scores were assessed preoperatively, at 6 months postoperatively, and at 12 months postoperatively.

Results: A total of 20 shoulders in 19 patients, with an average age of 60 years, were included in the study. Twelve patients met the criterion for the minimal clinically important difference in the SPADI score. The mean SPADI score showed significant improvement from 51.3% to 10.4% at 1-year follow-up. Active abduction improved from 65.4° to 149.3° and active forward flexion improved from 68.6° to 151.4° at 1-year follow-up. The procedure had a 30% complication rate, including a 15% rate of immunologic rejection of the xenograft. Five patients underwent revision procedures, including arthroscopic debridement and removal of xenograft residuals, implantation of a balloon spacer, and revision SCR with a fascia lata autograft.

Conclusions: Arthroscopic SCR with an acellular porcine dermal xenograft led to a successful outcome in 60% of cases. The procedure showed a quite high complication rate; the most severe cases were related to acute immunologic rejection of the xenograft.

Level of evidence: Level IV, case series.

© 2019 by the Arthroscopy Association of North America. Published by Elsevier Inc.

Figures

Fig 1
Fig 1
Shoulder function after superior capsular reconstruction with acellular porcine dermal xenograft assessed by the Shoulder Pain and Disability Index (SPADI). Patients were assessed with the SPADI questionnaire preoperatively, at 6 months postoperatively, and at 1 year postoperatively.

References

    1. Le B.T., Wu X.L., Lam P.H., Murrell G.A. Factors predicting rotator cuff retears: An analysis of 1000 consecutive rotator cuff repairs. Am J Sports Med. 2014;42:1134–1142.
    1. Galatz L.M., Ball C.M., Teefey S.A., Middleton W.D., Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86:219–224.
    1. Paxton E.S., Teefey S.A., Dahiya N., Keener J.D., Yamaguchi K., Galatz L.M. Clinical and radiographic outcomes of failed repairs of large or massive rotator cuff tears: Minimum ten-year follow-up. J Bone Joint Surg Am. 2013;95:627–632.
    1. Ladermann A., Collin P., Athwal G.S., Scheibel M., Zumstein M.A., Nourissat G. Current concepts in the primary management of irreparable posterosuperior rotator cuff tears without arthritis. EFORT Open Rev. 2018;3:200–209.
    1. Ainsworth R. Physiotherapy rehabilitation in patients with massive, irreparable rotator cuff tears. Musculoskeletal Care. 2006;4:140–151.
    1. Levy O., Mullett H., Roberts S., Copeland S. The role of anterior deltoid reeducation in patients with massive irreparable degenerative rotator cuff tears. J Shoulder Elbow Surg. 2008;17:863–870.
    1. Yian E.H., Sodl J.F., Dionysian E., Schneeberger A.G. Anterior deltoid reeducation for irreparable rotator cuff tears revisited. J Shoulder Elbow Surg. 2017;26:1562–1565.
    1. Levy H.J., Gardner R.D., Lemak L.J. Arthroscopic subacromial decompression in the treatment of full-thickness rotator cuff tears. Arthroscopy. 1991;7:8–13.
    1. Zvijac J.E., Levy H.J., Lemak L.J. Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: A 3- to 6-year follow-up. Arthroscopy. 1994;10:518–523.
    1. Barber F.A., Burns J.P., Deutsch A., Labbe M.R., Litchfield R.B. A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthroscopy. 2012;28:8–15.
    1. Boileau P., Baque F., Valerio L., Ahrens P., Chuinard C., Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007;89:747–757.
    1. Bond J.L., Dopirak R.M., Higgins J., Burns J., Snyder S.J. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: Technique and preliminary results. Arthroscopy. 2008;24:403–409.e1.
    1. Henseler J.F., Nagels J., van der Zwaal P., Nelissen R.G. Teres major tendon transfer for patients with massive irreparable posterosuperior rotator cuff tears: Short-term clinical results. Bone Joint J. 2013;95-B:523–529.
    1. Jones C.R., Snyder S.J. Massive irreparable rotator cuff tears: A solution that bridges the gap. Sports Med Arthrosc Rev. 2015;23:130–138.
    1. Kanatli U., Ozer M., Ataoglu M.B., et al. Arthroscopic-assisted latissimus dorsi tendon transfer for massive, irreparable rotator cuff tears: Technique and short-term follow-up of patients with pseudoparalysis. Arthroscopy. 2017;33:929–937.
    1. Ernstbrunner L., Suter A., Catanzaro S., Rahm S., Gerber C. Reverse total shoulder arthroplasty for massive, irreparable rotator cuff tears before the age of 60 years: Long-term results. J Bone Joint Surg Am. 2017;99:1721–1729.
    1. Petrillo S., Longo U.G., Papalia R., Denaro V. Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: A systematic review. Musculoskelet Surg. 2017;101:105–112.
    1. Sellers T.R., Abdelfattah A., Frankle M.A. Massive rotator cuff tear: When to consider reverse shoulder arthroplasty. Curr Rev Musculoskelet Med. 2018;11:131–140.
    1. Sershon R.A., Van Thiel G.S., Lin E.C., et al. Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years. J Shoulder Elbow Surg. 2014;23:395–400.
    1. Mihata T., McGarry M.H., Pirolo J.M., Kinoshita M., Lee T.Q. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: A biomechanical cadaveric study. Am J Sports Med. 2012;40:2248–2255.
    1. Ishihara Y., Mihata T., Tamboli M., et al. Role of the superior shoulder capsule in passive stability of the glenohumeral joint. J Shoulder Elbow Surg. 2014;23:642–648.
    1. Mihata T., Lee T.Q., Watanabe C., et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29:459–470.
    1. Adams C.R., Denard P.J., Brady P.C., Hartzler R.U., Burkhart S.S. The arthroscopic superior capsular reconstruction. Am J Orthop (Belle Mead NJ) 2016;45:320–324.
    1. Burkhart S.S., Denard P.J., Adams C.R., Brady P.C., Hartzler R.U. Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff repair. Arthrosc Tech. 2016;5:e1407–e1418.
    1. Denard P.J., Brady P.C., Adams C.R., Tokish J.M., Burkhart S.S. Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft. Arthroscopy. 2018;34:93–99.
    1. Liotard J.P., Cochard P., Walch G. Critical analysis of the supraspinatus outlet view: Rationale for a standard scapular Y-view. J Shoulder Elbow Surg. 1998;7:134–139.
    1. Nove-Josserand L., Edwards T.B., O'Connor D.P., Walch G. The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res. 2005:90–96.
    1. Roy J.S., MacDermid J.C., Woodhouse L.J. Measuring shoulder function: A systematic review of four questionnaires. Arthritis Rheum. 2009;61:623–632.
    1. Hartzler R.U., Burkhart S.S. Superior capsular reconstruction. Orthopedics. 2017;40:271–280.
    1. Pennington W.T., Bartz B.A., Pauli J.M., Walker C.E., Schmidt W. Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: Short-term clinical outcomes and the radiographic parameter of superior capsular distance. Arthroscopy. 2018;34:1764–1773.
    1. Wong M.L., Wong J.L., Vapniarsky N., Griffiths L.G. In vivo xenogeneic scaffold fate is determined by residual antigenicity and extracellular matrix preservation. Biomaterials. 2016;92:1–12.
    1. Ansaloni L., Cambrini P., Catena F., et al. Immune response to small intestinal submucosa (surgisis) implant in humans: Preliminary observations. J Invest Surg. 2007;20:237–241.
    1. Hoganson D.M., O'Doherty E.M., Owens G.E., et al. The retention of extracellular matrix proteins and angiogenic and mitogenic cytokines in a decellularized porcine dermis. Biomaterials. 2010;31:6730–6737.
    1. Mantovani F., Trinchieri A., Castelnuovo C., Romano A.L., Pisani E. Reconstructive urethroplasty using porcine acellular matrix. Eur Urol. 2003;44:600–602.
    1. Smith M., Hooks V.H., Jenkins B. Patch repair of ileoanal pouch-vaginal fistula with Permacol collagen implant. Am Surg. 2007;73:514–515.
    1. Wong M.L., Griffiths L.G. Immunogenicity in xenogeneic scaffold generation: Antigen removal vs. decellularization. Acta Biomater. 2014;10:1806–1816.
    1. Goncalves A.C., Griffiths L.G., Anthony R.V., Orton E.C. Decellularization of bovine pericardium for tissue-engineering by targeted removal of xenoantigens. J Heart Valve Dis. 2005;14:212–217.
    1. Cissell D.D., Hu J.C., Griffiths L.G., Athanasiou K.A. Antigen removal for the production of biomechanically functional, xenogeneic tissue grafts. J Biomech. 2014;47:1987–1996.
    1. Keane T.J., Badylak S.F. The host response to allogeneic and xenogeneic biological scaffold materials. J Tissue Eng Regen Med. 2015;9:504–511.
    1. Keane T.J., Swinehart I.T., Badylak S.F. Methods of tissue decellularization used for preparation of biologic scaffolds and in vivo relevance. Methods. 2015;84:25–34.
    1. Bayrak A., Tyralla M., Ladhoff J., et al. Human immune responses to porcine xenogeneic matrices and their extracellular matrix constituents in vitro. Biomaterials. 2010;31:3793–3803.
    1. Xu H., Sandor M., Qi S., et al. Implantation of a porcine acellular dermal graft in a primate model of rotator cuff repair. J Shoulder Elbow Surg. 2012;21:580–588.
    1. Galili U. Induced anti-non gal antibodies in human xenograft recipients. Transplantation. 2012;93:11–16.
    1. Stone K.R., Abdel-Motal U.M., Walgenbach A.W., Turek T.J., Galili U. Replacement of human anterior cruciate ligaments with pig ligaments: A model for anti-non-gal antibody response in long-term xenotransplantation. Transplantation. 2007;83:211–219.
    1. Neumann J.A., Zgonis M.H., Rickert K.D., et al. Interposition dermal matrix xenografts: A successful alternative to traditional treatment of massive rotator cuff tears. Am J Sports Med. 2017;45:1261–1268.
    1. Stone K.R., Walgenbach A.W., Turek T.J., Somers D.L., Wicomb W., Galili U. Anterior cruciate ligament reconstruction with a porcine xenograft: A serologic, histologic, and biomechanical study in primates. Arthroscopy. 2007;23:411–419.
    1. Mihata T., Lee T.Q., Fukunishi K., et al. Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears. Am J Sports Med. 2018;46:1077–1083.
    1. Mihata T., McGarry M.H., Kahn T., Goldberg I., Neo M., Lee T.Q. Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears. Arthroscopy. 2016;32:418–426.
    1. Mihata T., Bui C.N.H., Akeda M., et al. A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear. J Shoulder Elbow Surg. 2017;26:2158–2166.
    1. Werner C.M., Steinmann P.A., Gilbart M., Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–1486.
    1. Bohsali K.I., Bois A.J., Wirth M.A. Complications of shoulder arthroplasty. J Bone Joint Surg Am. 2017;99:256–269.
    1. Groh G.I., Groh G.M. Complications rates, reoperation rates, and the learning curve in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23:388–394.
    1. El-Azab H.M., Rott O., Irlenbusch U. Long-term follow-up after latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Bone Joint Surg Am. 2015;97:462–469.
    1. Gerber C. Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff. Clin Orthop Relat Res. 1992:152–160.
    1. Grimberg J., Kany J., Valenti P., Amaravathi R., Ramalingam A.T. Arthroscopic-assisted latissimus dorsi tendon transfer for irreparable posterosuperior cuff tears. Arthroscopy. 2015;31:599–607.e1.
    1. Moroder P., Schulz E., Mitterer M., Plachel F., Resch H., Lederer S. Long-term outcome after pectoralis major transfer for irreparable anterosuperior rotator cuff tears. J Bone Joint Surg Am. 2017;99:239–245.
    1. Gerber C., Rahm S.A., Catanzaro S., Farshad M., Moor B.K. Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: Long-term results at a minimum follow-up of ten years. J Bone Joint Surg Am. 2013;95:1920–1926.

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