Open Anterior Capsular Reconstruction With a Dermal Allograft Is a Viable Nonarthroplasty Salvage Procedure for Irreparable Subscapularis Tears at a Minimum 2-Year Follow-up

Abstract

PurposeTo elucidate the clinical outcomes of patients who underwent anterior capsular reconstruction (ACR) with dermal allograft for irreparable subscapularis tears in native shoulders at a minimum of 2-year follow-up.MethodsThis study included patients who underwent ACR by a single surgeon between March 2015 and September 2018. Clinical and intraoperative findings were recorded. Patient-reported outcomes were evaluated pre- and postoperatively, including American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, General Health Short-Form 12 Physical Component Summary and patient satisfaction (on a 1-10 scale, with 10 = best). Failure was defined as revision subscapularis surgery or conversion to reverse total shoulder arthroplasty.ResultsSeven patients who underwent ACR at a mean age of 53 ± 7.3 years at the time of surgery were included. Median time from injury to surgery was 13.8 months (range 13.8-32.0 months). Two patients had concomitant superior capsular reconstruction. One patient progressed to a reverse total shoulder arthroplasty at 6.8 months. Minimum 2-year follow-up was obtained in the remaining 6 of 6 (100%) patients, with a mean follow-up of 3.4 years (range 2.0-6.2). There was significant improvement in the Quick Disabilities of the Arm, Shoulder and Hand score (preoperative: 32.7, postoperative: 9.5, P = .04), whereas the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, and SF-12 PCS scores demonstrated nonsignificant improvement. Median patient satisfaction was 9.5 (range 7-10).ConclusionsThis small cohort of patients had a significant improvement in Quick Disabilities of the Arm, Shoulder and Hand score, high patient satisfaction, and relatively low conversion rate to reverse total shoulder arthroplasty. These clinical outcomes demonstrate that ACR with a dermal allograft may be a viable salvage operation for irreparable subscapularis tears in the short-term.Level of EvidenceLevel IV, therapeutic case series.