Midterm outcome of superior capsular reconstruction using doubled acellular human dermal allograft for irreparable rotator cuff tear

Abstract

Thicker (folded) facia lata autografts have been shown to be superior to thinner grafts and single-layered acellular human dermal (HD) allografts for superior capsular reconstruction (SCR) in biomechanical studies. The aim of this study was to evaluate the mid-term clinical outcomes following SCR for irreparable supraspinatus tears using doubled (folded) HD allograft. Thirty-two patients who had undergone SCR using doubled HD allograft between February 2012 through January 2020 were recruited in a continuous manner in this retrospective study. The inclusion criteria were SCR performed for irreparable supraspinatus tear and a minimum of two years follow-up. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score. The secondary outcome measures were complications and revision surgery. A subgroup analysis was performed between patients who received a "Standard" graft of mean 3mm thickness or a "Thick" graft of mean 4.4mm thickness. One patient was lost to follow-up. A total of 31 patients (31 shoulder joints) were analyzed with mean follow-up duration of 48 months (range, 25-96 months). Following surgery, there was significant improvement in ASES score from 18.1 ± 14.3 (preoperative) to 76.3 ± 25.1 (postoperative) (P < 0.001) with a satisfactory clinical outcome obtained in 83.8% of the patients. In a subset of eight patients completing five-years follow-up, clinical improvements were sustained. The percentage of patients with a clinically successful outcome was higher with thick grafts compared to patients with standard grafts, although this failed to reach statistical significance (94.4% vs 69.2%, RR=1.36, 95%CI 0.93-1.99, P = 0.13). One patient within the standard group underwent revision surgery. SCR for irreparable rotator cuff tears with doubled HD allograft results in improved clinical outcomes and low reoperation at mid-term follow-up duration.