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Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 2, pp 231–239 | Cite as

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

  • Sungjoon Lim
  • Hassan AlRamadhan
  • Jae-Man Kwak
  • Hanpyo Hong
  • In-Ho JeonEmail author
Arthroscopy and Sports Medicine
  • 149 Downloads

Abstract

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 < 0.001). There was no remarkable progression of fatty infiltration after surgery. AHD increased from 5.3 mm preoperatively to 6.4 mm postoperatively (P < 0.016). Nine patients (29%) showed graft tear on follow-up MRI: 7 and 2 at the medial and lateral rows, respectively. Although the intact graft group showed better outcomes than the graft tear group (pain VAS score 2.3 vs. 3.0; ASES score 74.1 vs. 69.8; constant score 63.4 vs. 57.9), the results were not statistically significant.

Conclusions

Graft tear rate after ASCR assessed by MRI was 29%, and failures mostly occurred at the medial row. The graft tear group showed clinical improvement despite the recurred superior capsule defect.

Level of evidence

IV, case series, treatment study.

Keywords

Shoulder Rotator cuff tear Arthroscopic surgery Superior capsule reconstruction Graft tear MR imaging 

Notes

Acknowledgements

The authors thank Jeong Hee Park, CNS (Asan Medical Center, Seoul, South Korea) for providing assistance during data collection.

Funding

None.

Compliance with ethical standards

IRB/ethical committee approval

AMC IRB 2017-0487.

References

  1. 1.
    Badhe SP, Lawrence TM, Smith FD, Lunn PG (2008) An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elbow Surg 17:35S–39SCrossRefGoogle Scholar
  2. 2.
    Boileau P, Watkinson DJ, Hatzidakis AM, Balg F (2005) Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 14:147S–161SCrossRefGoogle Scholar
  3. 3.
    Bond JL, Dopirak RM, Higgins J, Burns J, Snyder SJ (2008) Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy 24:403–409 e401CrossRefGoogle Scholar
  4. 4.
    Burkhart SS (1993) Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical results, pathomechanics, and patient selection based on biomechanical parameters. Orthop Clin North Am 24:111–123Google Scholar
  5. 5.
    Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A (1994) Partial repair of irreparable rotator cuff tears. Arthroscopy 10:363–370CrossRefGoogle Scholar
  6. 6.
    Cerciello S, Monk AP, Visona E, Carbone S, Edwards TB, Maffulli N et al (2017) The influence of critical shoulder angle on secondary rotator cuff insufficiency following shoulder arthroplasty. Arch Orthop Trauma Surg 137:913–918CrossRefGoogle Scholar
  7. 7.
    Cho NS, Yi JW, Lee BG, Rhee YG (2010) Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique. Am J Sports Med 38:664–671CrossRefGoogle Scholar
  8. 8.
    Cuff D, Pupello D, Virani N, Levy J, Frankle M (2008) Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Jt Surg Am 90:1244–1251CrossRefGoogle Scholar
  9. 9.
    Duralde XA, Bair B (2005) Massive rotator cuff tears: the result of partial rotator cuff repair. J Shoulder Elbow Surg 14:121–127CrossRefGoogle Scholar
  10. 10.
    Ek ET, Neukom L, Catanzaro S, Gerber C (2013) Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years. J Shoulder Elbow Surg 22:1199–1208CrossRefGoogle Scholar
  11. 11.
    Fenlin JM Jr, Chase JM, Rushton SA, Frieman BG (2002) Tuberoplasty: creation of an acromiohumeral articulation-a treatment option for massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 11:136–142CrossRefGoogle Scholar
  12. 12.
    Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M (2005) The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Jt Surg Am 87:1697–1705Google Scholar
  13. 13.
    Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605CrossRefGoogle Scholar
  14. 14.
    Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Jt Surg Am 86-A:219–224CrossRefGoogle Scholar
  15. 15.
    Gerber C (1992) Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff. Clin Orthop Relat Res 275:152–160Google Scholar
  16. 16.
    Gerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK (2013) 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 Jt Surg Am 95:1920–1926CrossRefGoogle Scholar
  17. 17.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83Google Scholar
  18. 18.
    Grammont PM, Baulot E (1993) Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 16:65–68Google Scholar
  19. 19.
    Gruber G, Bernhardt GA, Clar H, Zacherl M, Glehr M, Wurnig C (2010) Measurement of the acromiohumeral interval on standardized anteroposterior radiographs: a prospective study of observer variability. J Shoulder Elbow Surg 19:10–13CrossRefGoogle Scholar
  20. 20.
    Gupta AK, Hug K, Berkoff DJ, Boggess BR, Gavigan M, Malley PC et al (2012) Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Med 40:141–147CrossRefGoogle Scholar
  21. 21.
    Hamada K, Fukuda H, Mikasa M, Kobayashi Y (1990) Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 254:92–96Google Scholar
  22. 22.
    Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ (2006) Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. J Bone Jt Surg Am 88:1238–1244CrossRefGoogle Scholar
  23. 23.
    Jeon YS, Kim RG, Shin SJ (2018) A novel remaining tendon preserving repair technique leads to improved outcomes in special rotator cuff tear patterns. Arch Orthop Trauma Surg.  https://doi.org/10.1007/s00402-018-2956-3 Google Scholar
  24. 24.
    Jost B, Puskas GJ, Lustenberger A, Gerber C (2003) Outcome of pectoralis major transfer for the treatment of irreparable subscapularis tears. J Bone Jt Surg Am 85-A:1944–1951CrossRefGoogle Scholar
  25. 25.
    Kim SJ, Lee IS, Kim SH, Lee WY, Chun YM (2012) Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy 28:761–768CrossRefGoogle Scholar
  26. 26.
    Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Jt Surg Am 89:1184–1193CrossRefGoogle Scholar
  27. 27.
    Lee BG, Cho NS, Rhee YG (2011) Results of arthroscopic decompression and tuberoplasty for irreparable massive rotator cuff tears. Arthroscopy 27:1341–1350CrossRefGoogle Scholar
  28. 28.
    McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen FA (2015) Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med 43:491–500CrossRefGoogle Scholar
  29. 29.
    Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T et al (2013) Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy 29:459–470CrossRefGoogle Scholar
  30. 30.
    Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ (2016) Biomechanical effects of acromioplasty on superior capsule reconstruction for irreparable supraspinatus tendon tears. Am J Sports Med 44:191–197CrossRefGoogle Scholar
  31. 31.
    Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ (2012) Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med 40:2248–2255CrossRefGoogle Scholar
  32. 32.
    Millett PJ, Espinoza C, Horan MP, Ho CP, Warth RJ, Dornan GJ et al (2017) Predictors of outcomes after arthroscopic transosseous equivalent rotator cuff repair in 155 cases: a propensity score weighted analysis of knotted and knotless self-reinforcing repair techniques at a minimum of 2 years. Arch Orthop Trauma Surg 137:1399–1408CrossRefGoogle Scholar
  33. 33.
    Muh SJ, Streit JJ, Wanner JP, Lenarz CJ, Shishani Y, Rowland DY et al (2013) Early follow-up of reverse total shoulder arthroplasty in patients sixty years of age or younger. J Bone Jt Surg Am 95:1877–1883CrossRefGoogle Scholar
  34. 34.
    Mulieri P, Dunning P, Klein S, Pupello D, Frankle M (2010) Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Jt Surg Am 92:2544–2556CrossRefGoogle Scholar
  35. 35.
    Nove-Josserand L, Edwards TB, O’Connor DP, Walch G (2005) The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res 433:90–96CrossRefGoogle Scholar
  36. 36.
    Pogorzelski J, Horan MP, Godin JA, Hussain ZB, Fritz EM, Millett PJ (2018) Achilles tendon allograft-augmented latissimus dorsi tendon transfer for the treatment of massive irreparable posterosuperior rotator cuff tears. Arch Orthop Trauma Surg.  https://doi.org/10.1007/s00402-018-2943-8 Google Scholar
  37. 37.
    Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr (1995) Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Jt Surg Am 77:857–866CrossRefGoogle Scholar
  38. 38.
    Russell RD, Knight JR, Mulligan E, Khazzam MS (2014) Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Jt Surg Am 96:265–271CrossRefGoogle Scholar
  39. 39.
    Saupe N, Pfirrmann CW, Schmid MR, Jost B, Werner CM, Zanetti M (2006) Association between rotator cuff abnormalities and reduced acromiohumeral distance. AJR Am J Roentgenol 187:376–382CrossRefGoogle Scholar
  40. 40.
    Sclamberg SG, Tibone JE, Itamura JM, Kasraeian S (2004) Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa. J Shoulder Elbow Surg 13:538–541CrossRefGoogle Scholar
  41. 41.
    Sugaya H, Maeda K, Matsuki K, Moriishi J (2007) Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Jt Surg Am 89:953–960CrossRefGoogle Scholar
  42. 42.
    Tashjian RZ, Hollins AM, Kim HM, Teefey SA, Middleton WD, Steger-May K et al (2010) Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med 38:2435–2442CrossRefGoogle Scholar
  43. 43.
    Toussaint B, Schnaser E, Bosley J, Lefebvre Y, Gobezie R (2011) Early structural and functional outcomes for arthroscopic double-row transosseous-equivalent rotator cuff repair. Am J Sports Med 39:1217–1225CrossRefGoogle Scholar
  44. 44.
    Walch G, Edwards TB, Boulahia A, Nove-Josserand L, Neyton L, Szabo I (2005) Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg 14:238–246CrossRefGoogle Scholar
  45. 45.
    Walton JR, Bowman NK, Khatib Y, Linklater J, Murrell GA (2007) Restore orthobiologic implant: not recommended for augmentation of rotator cuff repairs. J Bone Jt Surg Am 89:786–791Google Scholar
  46. 46.
    Werner CM, Steinmann PA, Gilbart M, Gerber C (2005) Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Jt Surg Am 87:1476–1486Google Scholar
  47. 47.
    Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C (2008) The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Jt Surg Am 90:2423–2431CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sungjoon Lim
    • 1
  • Hassan AlRamadhan
    • 2
  • Jae-Man Kwak
    • 1
  • Hanpyo Hong
    • 1
  • In-Ho Jeon
    • 1
    Email author
  1. 1.Department of Orthopaedic Surgery, College of Medicine, Asan Medical CenterUniversity of UlsanSeoulSouth Korea
  2. 2.Department of Orthopedic SurgeryPrince Sultan Military Medical CityRiyadhSaudi Arabia

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