Superior Capsular Reconstruction in Massive Irreparable Rotator Cuff Tears with Autograft and Allograft. Minimum 12-Months Follow Up of the First 14 Patients
ESSKA Academy. YIANNAKOPOULOS C. 05/09/18; 209941; P22-1489 Topic: A10 - Head depressing procedures (open, e.g. balloon, superior capsule reconstruction, etc.)
Prof. Christos YIANNAKOPOULOS
Prof. Christos YIANNAKOPOULOS
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Abstract
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Objectives: The purpose of this study is to present the initial results from the clinical use of the technique of superior capsular reconstruction in patients with irreparable rotator cuff tears using an allograft or an autograft.

Methods: In this study we included the first 14 patients who underwent superior capsular reconstruction due a symptomatic and irreparable rotator cuff tear. The mean patient age was 64 years (56-69). Five patients had already subjected to a failed arthroscopic partial rotator cuff repair and in the rest of them this was the first attempt to improve shoulder function. 6 patients had mild glenohumeral osteoarthritic changes without rest pain and 9 patients presented with pseudoparalysis. All patient underwent partial rotator cuff repair and reconstruction of the superior capsule with a fascia lata autograft (5 cases) and an allograft (9 cases). The graft was stabilized on the superior part of the glenoid using two double-loaded suture anchors and a double row fixation technique in the greater tuberosity using distally positioned knotless anchors to tension the graft. In all cases acromioplasty was performed. The minimum follow up time was 12 months (12-20 months).

Results: The mean duration of the operation was 112 minutes in the allograft group and 128 minutes in the autograft group. Two patients reported pain and a muscle hernia in the thigh from harvesting of the fascia lata. The mean Constant score improved from 32 to 71and the mean Oxford from 25 to 47. The subjective VAS score improved from 3,1+/-2.6/10 preoperative to 7.4+/-2.2/10 postoperatively. Glenohumeral arthritis increased in one patient with worsening of the pain but due to the significantly improved function he declined the option of a reverse shoulder arthroplasty.

Conclusions: Superior capsular reconstruction in massive, irreparable rotator cuff tear is time consuming and costly but it is rather effective in cases with limited therapeutic options.

Keywords:
shoulder, rotator cuff, superior capsular reconstruction
Objectives: The purpose of this study is to present the initial results from the clinical use of the technique of superior capsular reconstruction in patients with irreparable rotator cuff tears using an allograft or an autograft.

Methods: In this study we included the first 14 patients who underwent superior capsular reconstruction due a symptomatic and irreparable rotator cuff tear. The mean patient age was 64 years (56-69). Five patients had already subjected to a failed arthroscopic partial rotator cuff repair and in the rest of them this was the first attempt to improve shoulder function. 6 patients had mild glenohumeral osteoarthritic changes without rest pain and 9 patients presented with pseudoparalysis. All patient underwent partial rotator cuff repair and reconstruction of the superior capsule with a fascia lata autograft (5 cases) and an allograft (9 cases). The graft was stabilized on the superior part of the glenoid using two double-loaded suture anchors and a double row fixation technique in the greater tuberosity using distally positioned knotless anchors to tension the graft. In all cases acromioplasty was performed. The minimum follow up time was 12 months (12-20 months).

Results: The mean duration of the operation was 112 minutes in the allograft group and 128 minutes in the autograft group. Two patients reported pain and a muscle hernia in the thigh from harvesting of the fascia lata. The mean Constant score improved from 32 to 71and the mean Oxford from 25 to 47. The subjective VAS score improved from 3,1+/-2.6/10 preoperative to 7.4+/-2.2/10 postoperatively. Glenohumeral arthritis increased in one patient with worsening of the pain but due to the significantly improved function he declined the option of a reverse shoulder arthroplasty.

Conclusions: Superior capsular reconstruction in massive, irreparable rotator cuff tear is time consuming and costly but it is rather effective in cases with limited therapeutic options.

Keywords:
shoulder, rotator cuff, superior capsular reconstruction
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