Editorial Commentary: Human Dermal Allograft Is Preferable to Fascia Lata Autograft Based on Similar Outcomes Without Donor-Site Morbidity

doi:10.1016/j.arthro.2021.05.037

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 37, Issue 9, September 2021, Pages 2797-2799

https://doi.org/10.1016/j.arthro.2021.05.037 Get rights and content

Abstract

Superior capsular reconstruction (SCR) is increasingly considered a “game-changer” for young patients with irreparable rotator cuff tears. Popular graft choices include fascia lata autograft (FLA) and human dermal allograft (HDA), with the latter strongly preferred in North America and Europe. Despite that, there seems to be a general perception that FLAs are associated with better healing rates due to better biology. However, critical analysis of the literature demonstrates abundant limitations that preclude strong conclusions about whether one graft type is optimal. Furthermore, recent studies have demonstrated that HDAs used for SCR have good healing potential and are also associated with generally good short-term clinical outcomes. A clinical pearl is that humeral sided repair failures are not uncommon, and double-row repair techniques should be thoughtfully considered. The main downside of FLAs is the associated donor site morbidity. Given the lack of proven advantage of FLAs, the impetus to move away from the current trend to use HDAs is low.

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There are more references available in the full text version of this article.

Cited by (3)

The Number of Surgeons Using Superior Capsular Reconstruction for Rotator Cuff Repair Is Declining
2022, Arthroscopy, Sports Medicine, and Rehabilitation
Citation Excerpt :
Studies report excellent clinical results after SCR using primarily a thick-folded autologous FL graft.7,8,26 In an effort to minimize donor-site morbidity12,16 and expedite surgery, the use of acellular dermal allografts has become a popular alternative15 to autografts in the United States.14,27 A recent systematic review of 14 studies commonly reported complications of SCR using dermal allografts, such as graft retear due to rupture of graft, anchor displacement, revision, reoperation, and infection.12
To investigate surgeon preferences for graft use, including biologic augmentation and superior capsular reconstruction (SCR) associated with surgical treatment of rotator cuff repair (RCR).
A 26-question survey was completed by arthroscopic shoulder surgeons. Surgeon demographics were evaluated. Surgeons were queried about shoulder arthroscopic graft use and rationale then responses were analyzed based on demographics.
In total, 260 surgeons completed the survey. Fifty-one percent of surgeons reported a decrease in the volume of SCR use in the past 5 years. Less than 3% of surgeons used SCR in >90% of irreparable RCR cases, compared with 38% using SCR in <10% of irreparable cases (P < .05). Surgeons performing >100 RCR annually (42%; P < .05) and those employed in the hospital setting (44%; P < .05) reported an overall increase in the use of SCR. More international surgeons (67%) decreased their use of SCR compared with U.S. surgeons (44%; P < .05). In contrast, bioinductive graft use is generally on the rise, with 48% of surgeons reporting increased use since first use, although used in <10% of cases by 54% of surgeons. Sixty-eight percent of surgeons performing >100 RCRs annually used bioinductive grafts (P < .05). Fewer international surgeons (30%) performed biologic augmentation (P < .05). Suboptimal published outcomes (40%) and no perceived patient benefit (40%) were most cited for decreased SCR use. Surgeons reporting increased use cited improved personal patient outcomes (72%).
Arthroscopic surgeons report decrease in volume of SCR use in the past 5 years. Surgeon’s personal experience of patient outcome and suboptimal published results were the strongest factors impacting decision-making. In contrast, bioinductive graft use is increasing. However, most surgeons use these grafts in a relatively small percentage of cases.
Evaluation of scientific data, personal experience, and influences on surgical practice will give a comprehensive understanding of current RCR practices.
Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed
2022, Arthroscopy - Journal of Arthroscopic and Related Surgery
Delayed treatment of shoulder instability results in bone loss requiring more-complicated surgery, in turn resulting in less-optimal outcomes. Similarly, delayed treatment of repairable rotator cuff tears results in irreparable tears requiring more-complicated surgery and resulting in less-optimal outcomes. Delayed treatment of shoulder pathology is a problem. Solutions include education and research investigation.
Superior capsular reconstruction using the long head of the biceps to treat massive rotator cuff tears improves patients shoulder pain, mobility and function
2023, Knee Surgery, Sports Traumatology, Arthroscopy

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Editorial CommentaryEditorial Commentary: Human Dermal Allograft Is Preferable to Fascia Lata Autograft Based on Similar Outcomes Without Donor-Site Morbidity

Abstract

Arthroscopy

Orthopaed Traumatol Surg Res

Arthroscopy

J Shoulder Elbow Surg

Single- versus double-row repair for full-thickness rotator cuff tears using suture anchors. A systematic review and meta-analysis of basic biomechanical studies

Eur J Orthop Surg Traumatol

Editorial Commentary
Editorial Commentary: Human Dermal Allograft Is Preferable to Fascia Lata Autograft Based on Similar Outcomes Without Donor-Site Morbidity