Clinical effectiveness of mini-open superior capsular reconstruction using autologous tensor fascia lata graft

Abstract

When one is performing superior capsular reconstruction (SCR), graft thickness is an important factor for achieving sufficient glenohumeral stability. However, when a graft of sufficient length and thickness is prepared and inserted into the subacromial space, it is often challenging to secure the field of view arthroscopically. To solve this problem, we devised a mini-open SCR technique. This study aimed to compare the clinical effectiveness of this technique with that of arthroscopic SCR. This retrospective cohort study included 46 consecutive patients with Hamada classification grade 2-3b who were treated between June 2014 and February 2018 with SCR performed by a single surgeon for irreparable rotator cuff tears (grade 3 or higher according to the Goutallier classification) using autologous tensor fascia lata. We evaluated the duration of the operation, length of the skin incision of the lateral portal used to insert the graft, graft size (length, width, and thickness), American Shoulder and Elbow Surgeons score, range of motion, and graft retear rate. This study included 46 patients who underwent arthroscopic SCR (n = 20) or mini-open SCR (n = 26). The mean follow-up period was 36.5 months (range, 24-66 months). The operative duration was significantly longer in the arthroscopic SCR group than in the mini-open SCR group (175 ± 48 minutes vs. 133 ± 25 minutes, P < .001); however, no significant difference was noted in the length of the skin incision (2.4 ± 0.2 cm vs. 2.5 ± 0.1 cm) and graft size. At the final follow-up, no significant differences were observed in American Shoulder and Elbow Surgeons scores, all ranges of motion (flexion, P = .60; abduction, P = .60; external rotation, P = .20; and internal rotation, P = .54), and graft retear rates (5% [1 case] vs. 3.8% [1 case], P > .999). Good clinical outcomes were obtained in both the arthroscopic and mini-open SCR groups. The surgical stress experienced by the patients who underwent mini-open SCR was similar to that experienced by those who underwent the arthroscopic technique, as no significant difference was noted in the length of the skin incision. This study shows that mini-open SCR, which contributes to reductions in operative duration and difficulty associated with the surgical technique, is an effective and alternative method to arthroscopic SCR.