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Graft tears after arthroscopic superior capsule reconstruction (ASCR): pattern of failure and its correlation with clinical outcome

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Arthroscopic superior capsule reconstruction (ASCR) using fascia lata autograft is a new surgical technique developed to overcome irreparable rotator cuff tears. There is little information about graft tear after ASCR and its impact on clinical outcome. This study is to investigate the graft tear rate, pattern of failure, and its correlation with clinical outcomes after arthroscopic superior capsule reconstruction (ASCR).

Materials and methods

From June 2013 to June 2016, 31 shoulders in 31 consecutive patients (mean 65.3 years) underwent ASCR using fascia lata autograft for irreparable large-to-massive tears. Magnetic resonance imaging (MRI) was performed before surgery and at mean 12.8 months (12–24 months) after surgery to assess fatty infiltration progression and graft integrity. Graft tear was defined as the loss of graft continuity and was categorized as medial and lateral rows according to the failure location. Acromiohumeral distance (AHD) was pre- and postoperatively measured with the standard radiograph. Pain visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, constant score, and physical examination were used to assess clinical outcomes. Average follow-up was 15 months (range 12–24 months) after surgery.

Results

Mean active forward elevation increased from 133° to 146° (P = 0.011). Mean VAS score, ASES score, and constant score significantly improved: from 6 to 2.5, 54.4 to 73.7, and 51.7 to 63.7, respectively (P < 0.001). There was no remarkable progression of fatty infiltration after surgery. AHD increased from 5.3 mm preoperatively to 6.4 mm postoperatively (P < 0.016). Nine patients (29%) showed graft tear on follow-up MRI: 7 and 2 at the medial and lateral rows, respectively. Although the intact graft group showed better outcomes than the graft tear group (pain VAS score 2.3 vs. 3.0; ASES score 74.1 vs. 69.8; constant score 63.4 vs. 57.9), the results were not statistically significant.

Conclusions

Graft tear rate after ASCR assessed by MRI was 29%, and failures mostly occurred at the medial row. The graft tear group showed clinical improvement despite the recurred superior capsule defect.

Level of evidence

IV, case series, treatment study.

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Acknowledgements

The authors thank Jeong Hee Park, CNS (Asan Medical Center, Seoul, South Korea) for providing assistance during data collection.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, College of Medicine, Asan Medical Center, University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 05505, South Korea

    Sungjoon Lim, Jae-Man Kwak, Hanpyo Hong & In-Ho Jeon

  2. Department of Orthopedic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

    Hassan AlRamadhan

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  1. Sungjoon Lim
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Correspondence to In-Ho Jeon.

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IRB/ethical committee approval

AMC IRB 2017-0487.

Additional information

The authors or their immediate families have not received any financial payment or benefits from any commercial company related to this study. The keynote of this paper was presented at AANA17—the 36th Annual Meeting of the Arthroscopy Association of North America, Denver, Colorado, May 18–20, 2017.

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

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  • DOI: https://doi.org/10.1007/s00402-018-3025-7

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