Superior Capsular Reconstruction Using 3‐layered Fascia Lata Autograft Reinforced with a Nonresorbable Suture Mesh
Martin Polacek, Cecilie P. Nyegaard
Abstract
Purpose The purpose of this study was to evaluate the short‐term clinical outcomes and the complications related to arthroscopic superior capsular reconstruction (SCR) using a 3‐layered fascia lata autograft (FLA) reinforced with a nonresorbable suture mesh, in the treatment of irreparable massive rotator cuff tears (MRCTs). Methods Consecutive patients with irreparable MRCTs (Goutallier 4, Hamada grade 1‐2, Bateman 3‐4) who were treated with arthroscopic SCR using reinforced FLA in 2018 were included. Patients with an irreparable subscapularis/infraspinatus, serious cardiovascular condition, systemic infection, rheumatic disease, and known alcohol/drug abuse were excluded from the study. Range of motion and Shoulder Pain and Disability Index (SPADI) scores were assessed preoperatively, at 6 months, and at 12 months postoperatively. A simple t test was used to compare the outcomes. P values <.05 were considered significant. Complications and revision surgeries were registered. Results A total of 24 consecutive patients (15 males, 9 females) with a mean age of 61 years (range, 41‐76) were enrolled. Twenty (83%) patients achieved minimal clinically important difference in the SPADI score (>18) and 14 (58%) experienced substantial clinical benefit in SPADI (>45). The mean SPADI score improved from 59.0 to 9.7 ( P < .0001) at 1‐year follow‐up. Active abduction improved from 59.5° to 154.3° ( P < .0001) and active forward flexion improved from 67.0° to 160.3° ( P < .0001) at 1‐year follow‐up. Eighteen (75%) patients achieved substantial clinical benefit in active abduction (>28.5°) and active forward flexion (>35.4°). Complications included progression of osteoarthritis in 2 cases, tear of the graft in 1 case, and pullout of the anchor in another. Two patients experienced donor site morbidity after harvesting the fascia lata autograft. Conclusions Eighty‐three percent of the patients achieved minimal clinically important difference and were successfully treated with arthroscopic SCR using a FLA reinforced with a suture mesh. The procedure had a complication rate of 17% and 8.5% of the patients experienced donor site morbidity. All complications occurred in patients who were previously treated with an attempted rotator cuff repair. Level of Evidence Level IV, therapeutic case series.