Clinical and Ecographical/ultrasound Partial Results on Superior Capsular Reconstruction for Rotator Cuff Irreparable Tears

Acta of Shoulder and Elbow Surgery | Volume 2 | Issue 2 | July-Dec 2017 | Page 24-26 | Byron Torres, Paúl Terán

Authors: Byron Torres [1], Paúl Terán [1].

[1] Hospital Metropolitano de Quito Hospital Vozandes de Quito Sociedad Latinoamericana de Hombro y Codo

Address of Correspondence
Dr. Byron Torres D.
Hospital Metropolitano de Quito Hospital Vozandes de Quito
Sociedad Latinoamericana de Hombro y Codo
Email: btorres@ceoecuador.com

Abstract

Introduction: The rotator cuff irreparable tears cause pain and an important functional impairment in patients. The different strategies that we have to treat them, have given variable results and the great concern remains in how to hold the progression towards degenerative arthropathy. The superior capsular reconstruction seems to be a logical and biomechanically adequate concept with good clinical results. With this in mind, we set ourselves the objectives of carrying out this procedure assessing its replicability and perform a follow-up with ultrasound, functional scores and of patient satisfaction score.
Methods: It deals with a series of 10 cases with prospective follow-up (2 men and 8 women), who were performed the superior capsule reconstruction, by the same surgeon between January 2015 and February 2016 with an average follow-up of 6 months. All of them with irreparable rupture of the rotator cuff, not responding to conservative management. We performed shoulder arthroscopy and superior capsular reconstruction with autologous ipsilateral fascia lata graft.
Results: The DASH score was of 64 in average in the pre-surgical, and of 24 average in the post- surgical phases. The working module obtained 56 as average range in the pre-surgical and 18 as average in the post-surgical phases. The sports module obtained 56 in the average range during the pre-surgical and 22 of average in the post-surgical phases. All the 10 patients made known that they would repeat the proceeding towards the final follow-up, which in average was of 6 months. The average age of the patients was of 61.5 years, with a minimum age of 53 and the maximum of 67 years old. Graft’s width was assessed through ultrasound, in the most anterior part, intermediate part, and the most posterior part, being the narrower graft of 3mm in average and the thicker of 6.9 mm in average. The anteroposterior length was also assessed, with an average of 1.9 cm and values that ranged from 1.2 cm through 2.56 cm. Three out of 10 patients related occasional residual pain at the donor site.
Conclusions: The superior capsular reconstruction with fascia lata autograft Is a demanding but a replicable procedure that in our series had good clinical results in the medium term, and also had good to excellent results in functional and satisfaction scales. Up-to-date information suggests that long-term results are influenced by the width of the graft, but that goes beyond this follow-up. We are committed to keep track of the cases, so the thickness can be assessed further in time, and its impact in the results noted. This encourages us to continue with our cases so as to assess this data in the future and its impact on the results. Autologous grafting often generates some post-surgery discomfort, reason why maybe the heterologous grafting may be a better option, if available.
Keywords: superior capsular reconstruction, irreparable rotator cuff tear

References

1. Liem D, Lengers N, Dedy N, Poetzl W, Steinbeck J, Marquardt B. Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy 2008;24: 743-748.
2. Lee B, Cho N, Rhee Y. Results of arthroscopic decompression and tuberoplasty for irreparable massive rotator cuff tears. Arthroscopy 2011;27:1341-1350.
3. Kim S, Lee I, Kim S. Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy 2012;28:761-768.
4. YooJ,KohK,WooK,ShonM,KooK.Clinicalandradiographicresults of partial repairs in irreparable rotator cuff tears: Preliminary report. Arthroscopy 2010;26:E3
5. Wellmann M, Lichtenberg S, da Silva G, Magosch P, Habermeyer P. Results of arthroscopic partial repair of large retracted rotator cuff tears. Arthroscopy 2013;29: 1275-1282.
6. Holtby R, Razmjou H. A prospective outcome study of patients with large and massive rotator cuff tears: Role of complete vs. partial repair. Arthroscopy 2011;27:E88-E89
7. Mori D, Funakoshi N, Yamashita F. Arthroscopic surgery of irreparable large or massive rotator cuff tears with lowgrade fatty degeneration of the infraspinatus: Patch autograft procedure versus partial repair procedure. Arthroscopy 2013;29:1911-1921.
8. Chang V, Grimberg J, Kany J, Valenti P, Duranthon L, Garret J. Early clinical results of arthroscopic latissimus dorsi transfer for irreparable cuff tears. Arthroscopy 2012;28:E14 (abstr).
9. Yamakado K. Arthroscopic assisted latissimus dorsi transfer for irreparable cuff tears. Arthroscopy 2015;31: E11-E12
10. 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.
11. Mihata T, Lee TQ, Watanabe C, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29:459-470.
12. Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med. 2012;40:2248-2255.
13. Mihata T, Watanabe C, Fukunishi K, Tsujimura T, Ohue M, Kinoshita M. Clinical outcomes after arthroscopic superior capsular reconstructionfor irreparable rotator cuff tear. Shoulder Joint.2010;34:451-453
14. Maximilian Petri, M.D., Joshua A. Greenspoon, B.Sc., and Peter J. Millett, M.D., M.Sc., Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears , Arthroscopy Techniques, Vol 4, No 6 (December), 2015: pp e751-e755
15. Gupta A.K., Hug K., Berkoff D.J. Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Med. 2012;40:141–147
16. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ Biomechanical Effect of Thickness and Tension of Fascia Lata Graft on Glenohumeral Stability for Superior Capsule Reconstruction in Irreparable Supraspinatus Tears. Arthroscopy. 2016 Mar;32(3):418-26.
17. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ. Biomechanical Effects of Acromioplasty on Superior Capsule Reconstruction for Irreparable Supraspinatus Tendon Tears Am J Sports Med. 2016 Jan;44(1):191-7

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