Alexandre Lädermann1, Patrick J Denard2, Johannes Barth3, Nicolas Bonnevialle4, Etienne Lejeune5, Hugo Bothorel6, Geoffroy Nourrissat7. 1. Division of orthopaedics and trauma surgery, La Tour Hospital, avenue J.-D. Maillard 3, 1217 Meyrin, Switzerland; Faculty of medicine, University of Geneva, Geneva, Switzerland; Department of surgery, division of orthopaedics and trauma surgery, Geneva University Hospitals, Geneva, Switzerland. Electronic address: alexandre.laedermann@gmail.com. 2. Oregon Shoulder Institute, Medford, Oregon, USA. 3. Department of orthopedic surgery, Cèdres clinic, Échirolles, France. 4. Pierre-Paul-Riquet Hospital, University Hospital of Toulouse, Toulouse, France. 5. Saint-Luc-Bouge Clinic, Namur, Belgium. 6. Research department, La Tour Hospital, Meyrin, Switzerland. 7. Maussins Clinic, Paris, France.
Abstract
AIMS: Superior capsular reconstruction (SCR) is a treatment option for patients with massive irreparable rotator cuff tears. Different types of grafts from various donor sites have been described. There are no clinical studies comparing the different grafts available. The aim of this study is to compare the early clinical outcomes of patients who have undergone arthroscopic SCR with different types of grafts (allograft vs. autograft). MATERIAL AND METHODS: This study is a retrospective analysis of data collected prospectively, from patients who underwent arthroscopic SCR with either a long head of biceps autograft (LHB) (n=40) or an acellular dermal allograft (n=40), between March 2015 and April 2018. The pre- and postoperative clinical data were compared between the 2 groups, as well as the incidence and type of complications. RESULTS: All patients were monitored with a minimum follow-up of one year. Three patients (7.5%) in the autograft group, and 14 (35%) in the allograft group (p=0.005) had a complication, of which 2 (5%) and 5 (12.5%) respectively, required revision surgery (p=0.432). Linear regression ruled out any significant difference between the 2 groups, with respect to clinical scores. However, patients with a history of prior rotator cuff surgery had poorer results with regard to active elevation (β, -29.3; p=0.020), internal rotation (β, -3.4; p=0.003) and Subjective Shoulder Value (SSV) (β, -17.2; p=0.023). Older patients, as well as men, are associated with poorer postoperative internal rotation (β, -0.1; p=0.003 and β, -1.9; p=0.039 respectively), and type D lesions are associated with poorer external rotation and postoperative SSV (β, -11.3; p=0.012 and β, -12.4; p=0.048 respectively), compared to type C lesions. Postoperative graft integrity was improved in the autograft group compared to the allograft group. (Grade 1: 65.8% vs. 2.9%; Grade 5: 5.3% vs. 28.6%; p<0.001). CONCLUSIONS: In both groups, clinical scores improved after SCR in patients with irreparable rotator cuff tears. Fewer complications and revisions were observed with the autograft compared to the allograft. If the LHB was still in place during surgery, its use appears valid, given the reasonable cost and low rate of complications associated with it. If absent, an allograft is also an option, considering the potential clinical improvement. LEVEL OF EVIDENCE: III; Case-control study.
AIMS: Superior capsular reconstruction (SCR) is a treatment option for patients with massive irreparable rotator cuff tears. Different types of grafts from various donor sites have been described. There are no clinical studies comparing the different grafts available. The aim of this study is to compare the early clinical outcomes of patients who have undergone arthroscopic SCR with different types of grafts (allograft vs. autograft). MATERIAL AND METHODS: This study is a retrospective analysis of data collected prospectively, from patients who underwent arthroscopic SCR with either a long head of biceps autograft (LHB) (n=40) or an acellular dermal allograft (n=40), between March 2015 and April 2018. The pre- and postoperative clinical data were compared between the 2 groups, as well as the incidence and type of complications. RESULTS: All patients were monitored with a minimum follow-up of one year. Three patients (7.5%) in the autograft group, and 14 (35%) in the allograft group (p=0.005) had a complication, of which 2 (5%) and 5 (12.5%) respectively, required revision surgery (p=0.432). Linear regression ruled out any significant difference between the 2 groups, with respect to clinical scores. However, patients with a history of prior rotator cuff surgery had poorer results with regard to active elevation (β, -29.3; p=0.020), internal rotation (β, -3.4; p=0.003) and Subjective Shoulder Value (SSV) (β, -17.2; p=0.023). Older patients, as well as men, are associated with poorer postoperative internal rotation (β, -0.1; p=0.003 and β, -1.9; p=0.039 respectively), and type D lesions are associated with poorer external rotation and postoperative SSV (β, -11.3; p=0.012 and β, -12.4; p=0.048 respectively), compared to type C lesions. Postoperative graft integrity was improved in the autograft group compared to the allograft group. (Grade 1: 65.8% vs. 2.9%; Grade 5: 5.3% vs. 28.6%; p<0.001). CONCLUSIONS: In both groups, clinical scores improved after SCR in patients with irreparable rotator cuff tears. Fewer complications and revisions were observed with the autograft compared to the allograft. If the LHB was still in place during surgery, its use appears valid, given the reasonable cost and low rate of complications associated with it. If absent, an allograft is also an option, considering the potential clinical improvement. LEVEL OF EVIDENCE: III; Case-control study.