Skip to main content

Superior capsular reconstruction using hybrid graft for irreparable massive rotator cuff tear

Knee Surgery, Sports Traumatology, Arthroscopy (2023)Cite this article

Abstract

Purpose

To evaluate the clinical and radiological outcomes of arthroscopic superior capsular reconstruction (SCR) using hybrid grafts composed of tensor fascia lata autografts and human dermal allografts.

Methods

This study included 30 patients with chronic irreparable posterosuperior rotator cuff tears (RCTs) who underwent arthroscopic SCR using a hybrid graft composed of tensor fascia lata autograft and human dermal allograft. Clinical outcomes were evaluated using the pain visual analogue scale score, shoulder range of motion, American Shoulder and Elbow Surgeons score, constant score, University of California–Los Angeles score, and simple shoulder test score preoperatively and at least 2 years after surgery. Radiographic analysis included the Hamada classification grade, acromiohumeral distance (AHD), and graft integrity at 2 years after surgery.

Results

All patients exhibited significant clinical improvement in all functional outcome measurements, except external rotation (all P < 0.05). The number of patients who exhibited pseudoparalysis decreased from 7 (23.3%) to 2 (6.7%) postoperatively. Complications were not observed. Radiologically, the mean postoperative AHD increased significantly from 6.9 ± 1.6 cm to 8.8 ± 2.1 cm at 2 years postoperatively (P < 0.001). Twenty five out of the 30 (83.3%) patients showed successful graft healing, and all healing failures occurred on the humeral side. The differences between the healed-graft and failed-graft groups were significantly lower graft thickness (P = 0.001) and smaller AHD (P < 0.001) in the failed-graft group. Every functional outcome scores were not statistically different between healed-graft and failed-graft groups.

Conclusions

An arthroscopic SCR technique using a hybrid graft consisting of a tensor fascia lata autograft and human dermal allograft showed satisfactory clinical outcomes in patients with irreparable RCTs.

Level of evidence

IV.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Abd Elrahman AA, Sobhy MH, Abdelazim H, Omar Haroun HK (2020) Superior capsular reconstruction: fascia lata versus acellular dermal allograft: a systematic review. Arthrosc Sports Med Rehabil 2(4):e389–e397. https://doi.org/10.1016/j.asmr.2020.03.002

    Article  Google Scholar 

  2. Baek CH, Kim JG (2022) Shoulder superior capsular reconstruction hybrid graft thickness greater than preoperative acromiohumeral distance increases graft retear rate and subacromial erosion. Arthroscopy 38(6):1784–1792. https://doi.org/10.1016/j.arthro.2021.11.046

    Article  Google Scholar 

  3. Broida SE, Sweeney AP, Gottschalk MB, Woodmass JM, Wagner ER (2022) Clinical outcomes of latissimus dorsi tendon transfer and superior capsular reconstruction for irreparable rotator cuff tears: a systematic review. Eur J Orthop Surg Traumatol 32(6):1023–1043. https://doi.org/10.1007/s00590-021-03046-5

    Article  Google Scholar 

  4. Burkhart SS, Pranckun JJ, Hartzler RU (2020) Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery. Arthroscopy 36(2):373–380

    Article  Google Scholar 

  5. de Campos Azevedo CI, Andrade R, Leiria Pires Gago Angelo AC, Espregueira-Mendes J, Ferreira N, Sevivas N (2020) Fascia lata autograft versus human dermal allograft in arthroscopic superior capsular reconstruction for irreparable rotator cuff tears: a systematic review of clinical outcomes. Arthroscopy 36(2):579–591. https://doi.org/10.1016/j.arthro.2019.08.033

    Article  Google Scholar 

  6. Denard PJ, Brady PC, Adams CR, Tokish JM, Burkhart SS (2018) Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft. Arthroscopy 34(1):93–99

    Article  Google Scholar 

  7. Dong Hyun Kim YSJ, Kim K-R, Yoon JP (2021) The best options in superior capsular reconstruction. Clin Shoulder Elb 24(2):114–121. https://doi.org/10.5397/cise.2021.00136

    Article  Google Scholar 

  8. Fu F, Christel P, Miller M, Johnson D (2009) Graft selection for anterior cruciate ligament reconstruction. Instr Course Lect 58:337–354

    Google Scholar 

  9. 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(6):599–605

    Article  CAS  Google Scholar 

  10. 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 Joint Surg Am 86(2):219–224. https://doi.org/10.2106/00004623-200402000-00002

    Article  Google Scholar 

  11. Gimbel J, Van Kleunen J, Williams G, Thomopoulos S, Soslowsky L (2007) Long durations of immobilization in the rat result in enhanced mechanical properties of the healing supraspinatus tendon insertion site. J Biomech Eng 129(3):400–404

    Article  CAS  Google Scholar 

  12. Goutallier D, Postel J, Lavau L, Bernageau J (1999) Impact of fatty degeneration of the suparspinatus and infraspinatus msucles on the prognosis of surgical repair of the rotator cuff. Rev Chir Orthop Reparatrice Appar Mot 85(7):668–676

    CAS  Google Scholar 

  13. 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 304:78–83

    Article  Google Scholar 

  14. Hamada K, Fukuda H, Mikasa M, Kobayashi Y (1990) Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 254:92–96

    Article  Google Scholar 

  15. Hamada K, Yamanaka K, Uchiyama Y, Mikasa T, Mikasa M (2011) A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res 469(9):2452–2460. https://doi.org/10.1007/s11999-011-1896-9

    Article  Google Scholar 

  16. Hirahara AM, Adams CR (2015) Arthroscopic superior capsular reconstruction for treatment of massive irreparable rotator cuff tears. Arthrosc Tech 4(6):e637-641. https://doi.org/10.1016/j.eats.2015.07.006

    Article  Google Scholar 

  17. Hirahara AM, Andersen WJ, Panero AJ (2017) Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up. Am J Orthop (Belle Mead NJ) 46(6):266–278

    Google Scholar 

  18. Kim DH, Min SG, Lee HS, Lee HJ, Park KH, Chung SW, Dehdashtian A, Yoon JP (2021) Clinical outcome of rotator cuff repair in patients with mild to moderate glenohumeral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 29(3):998–1005. https://doi.org/10.1007/s00167-020-06307-8

    Article  Google Scholar 

  19. Kim MS, Hasan LK, Fathi A, Hasan SK, Haratian A, Bolia IK, Petrigliano FA, Weber AE, Gamradt SC, Liu JN (2022) Evaluation of spin in systematic reviews and meta-analyses of superior capsular reconstruction. J Shoulder Elbow Surg 31(8):1743–1750. https://doi.org/10.1016/j.jse.2022.03.015

    Article  Google Scholar 

  20. Kobayashi EF, Oak SR, Miller BS, Bedi A (2023) Treatment of massive rotator cuff tears with reverse shoulder arthroplasty. Clin Sports Med 42(1):157–173. https://doi.org/10.1016/j.csm.2022.08.007

    Article  Google Scholar 

  21. Ladermann A, Denard PJ, Barth J, Bonnevialle N, Lejeune E, Bothorel H, Francophone Arthroscopy S, Nourrissat G, The SCRSFA group (2021) Superior capsular reconstruction for irreparable rotator cuff tears: autografts versus allografts. Orthop Traumatol Surg Res 107(8S):103059. https://doi.org/10.1016/j.otsr.2021.103059

    Article  Google Scholar 

  22. Lee GW, Kim JY, Lee HW, Yoon JH, Noh KC (2022) Clinical and anatomical outcomes of arthroscopic repair of large rotator cuff tears with allograft patch augmentation: a prospective, single-blinded, randomized controlled trial with a long-term follow-up. Clin Orthop Surg 14(2):263–271. https://doi.org/10.4055/cios21135

    Article  Google Scholar 

  23. Lee KW, Choi HG, Yang DS, Yu YT, Kim WS, Choy WS (2021) Achilles tendon allograft for superior capsule reconstruction in irreparable massive rotator cuff tears. Clin Orthop Surg 13(3):395–405. https://doi.org/10.4055/cios20284

    Article  Google Scholar 

  24. Lee SJ, Min YK (2018) Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction. Knee Surg Sports Traumatol Arthrosc 26(7):2205–2213. https://doi.org/10.1007/s00167-018-4912-8

    Article  Google Scholar 

  25. Leroux TS (2018) Editorial commentary: superior capsule reconstruction with dermal allograft: effective marketing or the real deal? Arthroscopy 34(1):102–104. https://doi.org/10.1016/j.arthro.2017.10.033

    Article  Google Scholar 

  26. Lim S, AlRamadhan H, Kwak JM, Hong H, Jeon IH (2018) Graft tears after arthroscopic superior capsule reconstruction (ASCR): pattern of failure and its correlation with clinical outcome. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3025-7

    Article  Google Scholar 

  27. Lim S, AlRamadhan H, Kwak JM, Hong H, Jeon IH (2019) Graft tears after arthroscopic superior capsule reconstruction (ASCR): pattern of failure and its correlation with clinical outcome. Arch Orthop Trauma Surg 139(2):231–239. https://doi.org/10.1007/s00402-018-3025-7

    Article  Google Scholar 

  28. Mease SJ, Wang KC, Cautela FS, Parsons BO (2023) Tendon transfers, balloon spacers, and bursal acromial reconstruction for massive rotator cuff tears. Clin Sports Med 42(1):125–140. https://doi.org/10.1016/j.csm.2022.08.011

    Article  Google Scholar 

  29. Mihata T, Bui CNH, Akeda M, Cavagnaro MA, Kuenzler M, Peterson AB, McGarry MH, Itami Y, Limpisvasti O, Neo M, Lee TQ (2017) A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear. J Shoulder Elbow Surg 26(12):2158–2166

    Article  Google Scholar 

  30. Mihata T, Lee TQ, Fukunishi K, Itami Y, Fujisawa Y, Kawakami T, Ohue M, Neo M (2018) Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears. Am J Sports Med 46(5):1077–1083. https://doi.org/10.1177/0363546517753387

    Article  Google Scholar 

  31. Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, Kinoshita M (2013) Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy 29(3):459–470. https://doi.org/10.1016/j.arthro.2012.10.022

    Article  Google Scholar 

  32. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ (2016) Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears. Arthroscopy 32(3):418–426. https://doi.org/10.1016/j.arthro.2015.08.024

    Article  Google Scholar 

  33. 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(10):2248–2255

    Article  Google Scholar 

  34. Neri BR, Chan KW, Kwon YW (2009) Management of massive and irreparable rotator cuff tears. J Shoulder Elbow Surg 18(5):808–818. https://doi.org/10.1016/j.jse.2009.03.013

    Article  Google Scholar 

  35. Nimura A, Kato A, Yamaguchi K, Mochizuki T, Okawa A, Sugaya H, Akita K (2012) The superior capsule of the shoulder joint complements the insertion of the rotator cuff. J Shoulder Elbow Surg 21(7):867–872

    Article  Google Scholar 

  36. Nobuya Harada EI, Gotoh M, Shiba N (2022) The clinical outcomes of infraspinatus rotational transfer for irreparable posterosuperior rotator cuff tears: a preliminary report. Clin Shoulder Elb 25(3):195–201. https://doi.org/10.5397/cise.2021.00731

    Article  Google Scholar 

  37. Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS (2008) Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy 24(9):983–991

    Article  Google Scholar 

  38. Oh JH, Kim SH, Shin SH, Chung SW, Kim JY, Kim SJ (2011) Outcome of rotator cuff repair in large-to-massive tear with pseudoparalysis: a comparative study with propensity score matching. Am J Sports Med 39(7):1413–1420

    Article  Google Scholar 

  39. Pennington WT, Bartz BA, Pauli JM, Walker CE, Schmidt W (2018) Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: short-term clinical outcomes and the radiographic parameter of superior capsular distance. Arthroscopy 34(6):1764–1773

    Article  Google Scholar 

  40. Peterson RK, Shelton WR, Bomboy AL (2001) Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: a 5-year follow-up. Arthroscopy 17(1):9–13

    Article  CAS  Google Scholar 

  41. Rodriguez-Vaquero G, Lopez-Fernandez V, Calvo E (2022) Lower trapezius transfer for massive posterosuperior rotator cuff defects. Oper Orthop Traumatol 34(1):34–44. https://doi.org/10.1007/s00064-021-00756-1

    Article  Google Scholar 

  42. 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(2):376–382

    Article  Google Scholar 

  43. Scheiderer B, Kia C, Obopilwe E, Johnson JD, Cote MP, Imhoff FB, Dyrna F, Beitzel K, Imhoff AB, Adams CR, Mazzocca AD, Morikawa D (2020) Biomechanical effect of superior capsule reconstruction using a 3-mm and 6-mm thick acellular dermal allograft in a dynamic shoulder model. Arthroscopy 36(2):355–364. https://doi.org/10.1016/j.arthro.2019.08.026

    Article  Google Scholar 

  44. Shah NS, Suriel Peguero E, Umeda Y, Crawford ZT, Grawe BM (2022) Long-term outcomes of massive rotator cuff tear repair: a systematic review. HSS J 18(1):130–137. https://doi.org/10.1177/15563316211008137

    Article  Google Scholar 

  45. Takayama K, Shiode H, Ito H (2022) Acromial and humeral head osteolysis following superior capsular reconstruction using autologous tensor fascia lata graft. J Shoulder Elbow Surg 31(7):1479–1487. https://doi.org/10.1016/j.jse.2021.12.019

    Article  Google Scholar 

  46. Therrien E, Stuart MJ, Levy BA (2021) Editorial commentary: autograft beats allograft for most knee ligament surgery. Arthroscopy 37(3):951–952

    Article  Google Scholar 

  47. Thomopoulos S, Williams G, Soslowsky L (2003) Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels. J Biomech Eng 125(1):106–113

    Article  CAS  Google Scholar 

  48. Tokish JM, Beicker C (2015) Superior capsule reconstruction technique using an acellular dermal allograft. Arthrosc Tech 4(6):e833-839. https://doi.org/10.1016/j.eats.2015.08.005

    Article  Google Scholar 

  49. Trenerry K, Walton JR, Murrell GA (2005) Prevention of shoulder stiffness after rotator cuff repair. Clin Orthop Relat Res 430:94–99

    Article  Google Scholar 

  50. Uchida A, Mihata T, Neo M (2019) Subacromial bone erosion due to suture-knots in arthroscopic rotator cuff repair: a report of two cases. Asia Pac J Sports Med Arthrosc Rehabil Technol 16:30–35. https://doi.org/10.1016/j.asmart.2018.11.006

    Article  Google Scholar 

  51. Wasserstein D, Sheth U, Cabrera A, Spindler KP (2015) A systematic review of failed anterior cruciate ligament reconstruction with autograft compared with allograft in young patients. Sports Health 7(3):207–216

    Article  Google Scholar 

  52. Waterman BR (2022) Editorial commentary: increased graft thickness with superior capsular reconstruction results in improved acromiohumeral distance, but increased graft tear rate and lateral acromial erosion. Arthroscopy 38(6):1793–1795

    Article  Google Scholar 

  53. Yildiz F, Bilsel K, Pulatkan A, Kapicioglu M, Uzer G, Cetindamar T, Sonmez C, Bozdag E, Sunbuloglu E (2019) Comparison of two different superior capsule reconstruction methods in the treatment of chronic irreparable rotator cuff tears: a biomechanical and histologic study in rabbit models. J Shoulder Elbow Surg 28(3):530–538. https://doi.org/10.1016/j.jse.2018.08.022

    Article  Google Scholar 

  54. Zanini B, Rusconi M, Fornara P, Malgrati F, Grassi FA, Leigheb M (2022) Functional outcome of arthroscopic debridement for massive, irreparable rotator cuff tears. Acta Biomed 92(S3):e2021557

    Google Scholar 

Download references

Funding

This work has supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (NRF-2022R1A2C1005374).

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea

    Jong Pil Yoon, Dong-Hyun Kim, Jee wook Yoon, Youngsoo Jung & Kyeong Hyeon Park

  2. Department of Orthopaedic Surgery, School of Medicine, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea

    Jihwan Lee & Seok Won Chung

Authors
  1. Jong Pil Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dong-Hyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jee wook Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Youngsoo Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyeong Hyeon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jihwan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seok Won Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seok Won Chung.

Ethics declarations

Conflict of interest

All authors of this article declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yoon, J.P., Kim, DH., Yoon, J.w. et al. Superior capsular reconstruction using hybrid graft for irreparable massive rotator cuff tear. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07321-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00167-023-07321-2

Keywords

  • Superior capsular reconstruction
  • Hybrid graft
  • Tensor fascia lata
  • Human dermal allograft
  • Irreparable massive rotator cuff tear