Arthroscopic Superior Capsular Reconstruction With a Minimally Invasive Harvested Fascia Lata Autograft Produces Good Clinical Results

Clara Isabel de Campos Azevedo, Ana Catarina Leiria Pires Gago Ângelo, Susana Vinga, Clara Isabel de Campos Azevedo, Ana Catarina Leiria Pires Gago Ângelo, Susana Vinga

Abstract

Background: Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs) in active patients are a challenge. Arthroscopic superior capsular reconstruction (ASCR) is a new treatment option originally described using a fascia lata autograft harvested through an open approach. However, concerns about donor site morbidity have discouraged surgeons from using this type of graft.

Hypothesis: ASCR using a minimally invasive harvested fascia lata autograft produces good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years.

Study design: Case series; Level of evidence, 4.

Methods: From 2015 to 2016, a total of 22 consecutive patients (mean age, 64.8 ± 8.6 years) with chronic IRCTs (Hamada grade 1-2; Goutallier cumulative grade ≥3; Patte stage 1: 2 patients; Patte stage 2: 6 patients; Patte stage 3: 14 patients) underwent ASCR using a minimally invasive harvested fascia lata autograft. All patients completed preoperative and 6-month evaluations consisting of the Simple Shoulder Test (SST), subjective shoulder value (SSV), Constant score (CS), range of motion (ROM), acromiohumeral interval (AHI), and magnetic resonance imaging. Twenty-one patients completed the 2-year shoulder and donor site morbidity assessments.

Results: The mean active ROMs improved significantly (P < .001): elevation, from 74.8° ± 55.5° to 104.5° ± 41.9° (6 months) and 143.8° ± 31.7° (2 years); abduction, from 53.2° ± 43.3° to 86.6° ± 32.9° (6 months) and 120.7° ± 37.7° (2 years); external rotation, from 13.2° ± 18.4° to 27.0° ± 16.1° (6 months) and 35.6° ± 17.3° (2 years); and internal rotation, from 1.2 ± 1.5 points to 2.6 ± 1.5 points (6 months) and 3.8 ± 1.2 points (2 years). The mean functional shoulder scores improved significantly (P < .001): SST, from 2.1 ± 2.9 to 6.8 ± 3.5 (6 months) and 8.6 ± 3.5 (2 years); SSV, from 33.0% ± 17.4% to 55.7% ± 25.6% (6 months) and 70.0% ± 23.0% (2 years); CS, from 17.5 ± 13.4 to 42.5 ± 14.9 (6 months) and 64.9 ± 18.0 (2 years). The mean shoulder abduction strength improved significantly (P < .001) from 0.0 to 1.1 ± 1.4 kg (6 months) and 2.8 ± 2.6 kg (2 years). The mean AHI improved from 6.4 ± 3.3 mm to 8.0 ± 2.5 mm (6 months) and decreased to 7.1 ± 2.5 mm (2 years). This 0.7 ± 1.5-mm overall decrease was statistically significant (P = .042). At 6 months, 20 of 22 patients (90.9%) had no graft tears. At 2 years, 12 of 21 patients (57.1%) were bothered by their harvested thigh, 16 (76.2%) noticed donor site changes, 16 (76.2%) considered that the shoulder surgery's end result compensated for the thigh's changes, and 18 (85.7%) would undergo the same surgery again.

Conclusion: ASCR using a minimally invasive harvested fascia lata autograft produced good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years.

Keywords: donor site morbidity; fascia lata autograft; minimally invasive; rotator cuff tear; shoulder arthroscopic surgery; superior capsular reconstruction.

Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Arthroscopic images of the left shoulder and thigh harvest. Posterior portal view: (A) grasper test with a large tendon tear under traction, (B) debrided footprint of the supraspinatus and infraspinatus tendons, (C) measurement of the irreparable defect, (D) minimally invasive fascia lata graft harvest in the left thigh, (E) folded and peripherally sutured graft with suture anchor markings, (F) graft width, (G) superior glenoid anchors, (H) humeral footprint anchors, and (J) sutures passing through the graft and the double-pulley knot and graft ready to be shuttled intra-articularly through the lateral portal. Posterior portal: (I) intra-articular view of the graft, (K) subacromial view of the graft and overlying rotator cuff remnants, (L) subacromial view of the sutures passing through the supraspinatus after the knots were tied, and (M) subacromial view of onlay partial rotator cuff tear repair after arming the lateral humeral anchors with the limbs of the sutures passing through the supraspinatus and infraspinatus. Anterior portal: (N) final intra-articular view of superior capsular reconstruction. FL, fascia lata graft; Gl, glenoid; GT, greater tuberosity; HH, humeral head; IS, infraspinatus tendon; SS, supraspinatus tendon.
Figure 2.
Figure 2.
Six-month postoperative magnetic resonance imaging: a healed graft on proton density fat-saturated (A) coronal and (C) sagittal images of patient 2 and a torn graft on proton density fat-saturated (B) coronal and (D) sagittal images of patient 9.

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