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Low healing rates and moderate functional outcome after arthroscopic superior capsular reconstruction using a porcine xenograft

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In the absence of arthropathy, symptomatic massive irreparable rotator cuff tears contribute to a therapeutic challenge for orthopedic surgeons. The concept of superior capsular reconstruction (SCR) was introduced as an option for these challenging cases. The purposes of this study were to evaluate the clinical outcome scores when using a decellularized porcine xenograft and to evaluate the graft healing and incorporation.

Methods

A multicentric retrospective study of consecutive SCR’s performed between 2016 and 2019 by four surgeons in four centers. Preoperative and postoperative Constant score, Subjective shoulder value (SSV) and Visual analog scale for pain (VAS) were recorded. Graft healing was evaluated by ultrasound or magnetic resonance imaging (MRI).

Results

A total of 28 shoulders were retrospectively analyzed with an average follow-up of 24 ± 9 months. One infection and four revisions (14%) to reversed shoulder arthroplasty (RSA) were reported at the final follow-up. The absolute Constant score showed a moderate, but significant improvement from 40 ± 12 to 57 ± 20 (P = 0.001). A significant improvement in pain scores was observed (P < 0.001). For patients undergoing SCR as a primary surgery, an average postoperative Constant score of 62 ± 16 was observed. This was in contrast to 43 ± 22 for patients who underwent SCR after failed rotator cuff repair. Although a strong trend in absolute differences was observed in regard to the Constant score, they did not reach statistical significance. For all other recorded outcome scores, a significant difference was reported between these groups. Graft healing was observed in (7/22) 30% of the patients. In the case of graft incorporation, an absolute constant score of 70 ± 9 was observed compared to 48 ± 21 in the graft failure group (P = 0.003). All cases with graft healing were considered to have a successful clinical outcome. This compared to only (7/15) 47% in the case of graft failure.

Conclusions

In these series, SCR with a dermal xenograft successfully alleviated pain, but provided only a moderate improvement in functional outcome. In the case of graft healing, satisfactory clinical outcomes and patient satisfaction were observed. The present study indicates the benefit of performing SCR as a primary surgery, yet warns against using SCR as a salvage option for failed rotator cuff repair. In this group, the use of dermal xenografts is limited by the low healing rates and high complication rate.

Level of evidence

IV. Retrospective case series, treatment study.

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Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France

    Michiel Cromheecke, Jérôme Garret & Samuel Gaudin

  2. AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium

    Michiel Cromheecke

  3. Clinique Drouot, 20 rue Laffitte, 75009, Paris, France

    Julien Deranlot

  4. Hôpital Pierre Paul Riquet, Allée Jean Dausset, 31059, Toulouse Cedex 09, France

    Nicolas Bonnevialle

  5. Institut de Recherche Riquet (I2R), Place du Docteur Baylac, 31059, Toulouse, France

    Nicolas Bonnevialle

  6. Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland

    Alexandre Lädermann

  7. Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Alexandre Lädermann

  8. Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland

    Alexandre Lädermann

  9. Clinique des Maussins - Ramsay Santé, 69 rue de Romainville, 75019, Paris, France

    Geoffroy Nourissat

Authors
  1. Michiel Cromheecke
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  2. Jérôme Garret
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  4. Nicolas Bonnevialle
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  5. Samuel Gaudin
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  6. Alexandre Lädermann
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  7. Geoffroy Nourissat
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Consortia

French Arthroscopic Society (SFA)

Contributions

MC and JG researched literature and conceived the study. JG, JD, GN and NB performed data collection and patient follow-up. MC and SG performed database completion and statistical analysis. MC wrote the first draft of the manuscript, with the help of JG, AL and GN. JG, AL and GN added critical remarks and corrections. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Michiel Cromheecke.

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Conflict of interest

JG: consult and designer for Move-up, Designer for FH and Wright medical, consultant for Zimmer Biomet; NB: Consultant for SBM and Conmed; AL: Consultant for Arthrex, Wright medical and Medacta, receives royalties from Wright medical; GN: Royalties and consulting for SBM, consultant for Arthrex, Mitek and Smith&Nephew. COI forms were completed and submitted. MC, SG and JD declare no potential conflicts of interest.

Ethical approval

Ethical approval was obtained from the clinique maussins-nollet ethics board (Maus-2019-11-02). This study was in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent for the retrospective use of the clinical data and imaging was obtained by the treating surgeons.

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Cromheecke, M., Garret, J., Deranlot, J. et al. Low healing rates and moderate functional outcome after arthroscopic superior capsular reconstruction using a porcine xenograft. Knee Surg Sports Traumatol Arthrosc 30, 2528–2534 (2022). https://doi.org/10.1007/s00167-022-06916-5

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  • DOI: https://doi.org/10.1007/s00167-022-06916-5

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