Fascia Lata Autograft Research Articles

Arthroscopically-Assisted Lower Trapezius Tendon Transfer Results in Similar Clinical and Structural Outcomes for Patients ≤60 and ≥70 Years Old

BackgroundArthroscopically-assisted lower trapezius tendon (aLTT) transfer has emerged as an effective surgical option for patients with posterior superior irreparable rotator cuff tears (PSIRCTs) who primarily complain of external rotation weakness and lag signs, in the absence of arthritis. The purpose of this study is to compare the clinical and structural outcome among different age groups in aLTT transfer for PSIRCTs. MethodsWe retrospectively reviewed patients who underwent aLTT transfer for PSIRCTs between May 2017 and September 2021. We included patients with PSIRCTs, minimal glenohumeral arthritis (Hamada grade ≤ 2), poor muscle quality (Goutallier grades ≥ 3), and a minimum follow-up of 2 years. Patients lacking a minimum of 2-year follow-up data and a postoperative MRI were excluded. For the purpose of the study, three groups were created: Group Total includes all ages, Group A consists of patients aged 60 and below, and Group B consists of patients aged 70 and above. We compared patient-reported outcome scores (VAS, Constant, UCLA, ASES, ADLER), pre- and postoperative range of motion (ROM), acromiohumeral distance (AHD), Hamada grade, graft integrity on postoperative MRI, and complications among the groups. ResultsEighty-four patients underwent aLTT transfer (51 with Achilles tendon allografts and 33 with fascia lata autografts), with a mean follow-up of 43.7 ± 14.6 months. There was significant improvement in VAS, Constant, UCLA, ASES, ADLER scores, and ROM in the entire cohort. When comparing Group A (n=23) and Group B (n=19), there were no significant differences in patient-reported outcomes, ROM, AHD, and Hamada grade. Additionally, we observed comparable clinical results, with similar rates of complications such as re-tear, postoperative stiff shoulder, and revision surgery between the groups. ConclusionThe current study demonstrates that aLTT transfer for PSIRCTs with minimal glenohumeral arthritis yields similar results between Group A and Group B. Additionally, the two different age groups did not show significantly different clinical results when compared to the entire cohort. Our findings contribute to a more comprehensive understanding of the applicability of aLTT transfer across different age groups, emphasizing its potential as a viable treatment option for a broader patient population.

Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears Yields Good Clinical Outcomes for Patients With and Without Diabetes Mellitus

PurposeTo compare the clinical outcomes after superior capsule reconstruction (SCR) for irreparable rotator cuff tears (RCTs) in patients with and without diabetes mellitus (DM). MethodPatients who underwent SCR using fascia lata autograft for irreparable RCTs between 2012 and 2020 with a minimum 2-year follow-up were divided into non-DM and DM groups. Propensity score matching was used to select controls matched for patients’ characteristics. Only patients with HbA1c <8% were eligible. The Visual Analog Scale (VAS) for shoulder pain, American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association scores, and acromiohumeral distance were evaluated preoperatively and at 2 years postoperatively. Shoulder active range of motion (ROM) was evaluated preoperatively, at 6 months, 1 year, and 2 years postoperatively. Graft integrity and postoperative complications required additional surgery were evaluated. The Wilcoxon signed-rank test and Mann-Whitney U test were used to compare continuous variables. Pearson’s chi-squared test and Fisher’s exact test were used for categorical variables. The interaction between the postoperative period and ROM were analyzed by Friedman test and Wilcoxon rank sum test with Holm-Sidak post-hoc test. ResultsWe studied 154 patients (non-DM, 130; DM, 24) who underwent SCR. After matching, 21 patients were selected in each group. All clinical outcomes significantly improved at 2 years (all P<0.05) in both groups. We found no significant differences in clinical outcomes and rates of patients who achieved minimal clinically important differences of VAS and ASES scores between the groups (P=0.10-1.0). The rates of graft tear (both 9.5%) and complications (non-DM, 4.8%; DM, 0%) were not significantly different (both P=1.0). ConclusionSCR using fascia lata autograft for irreparable RCTs yields good clinical outcomes, including ROM, in patients with and without DM. No significant differences in postoperative outcomes were observed between the two groups. Level of EvidenceRetrospective cohort study, Level III.

Fascia lata autograft for chronic Pectoralis Major ruptures - A technical note

Rupture of the pectoralis major tendon is an uncommon injury but increasing in incidence. Surgical management is often needed, and ruptures treated acutely show more favorable results. However, a significant number of ruptures are missed and diagnosed later in a chronic state. Direct suture without tension is a major challenge in these cases, and interposition grafts are required.Several techniques have been described however none uses a fascia lata autograft.This technical note aims to describe fascia lata autograft as a valid option to treat retracted chronic pectoralis major ruptures. Level of evidenceIV; Study Design: Technical Note.

Harvest of large fascia lata autograft: Outcomes in 108 patients.

Due to the reclassification of transvaginal mesh as a high-risk device, there has been renewed interest in the use of fascia lata in pelvic floor reconstruction. Here we report our experience in 108 patients who underwent large fascia lata harvest for pelvic organ prolapse (POP) repair. Our primary objective was to highlight the postoperative morbidity of the large fascia lata harvest in patients who underwent POP repair using fascia lata autograft. Surgery involved harvesting a fascia lata graft through a small lateral upper thigh incision and was used for either autologous transvaginal POP repair or autologous sacrocolpopexy. To prevent seroma, a temporary Jackson-Pratt drain was intraoperatively placed and a mild compression wrap was applied to the area for 4-6 weeks postoperatively. Patient demographics were obtained preoperatively, while physical exam findings and postoperative outcomes related to the fascia lata harvest were collected at sequential follow up visits. One-hundred eight patients underwent 111 large fascia lata harvests for either transvaginal or abdominal/robotic POP repair from July 2016 to January 2022. Mean follow-up was 19.6 months (range: 1-65) with 38 patients having 24 months or more of follow-up. Mean Visual Analog Pain (VAP) score was 1 (range: 0-10). Sixteen patients developed asymptomatic thigh bulges, 16 patients developed harvest site seromas (of which 14 resolved), and 59 patients experienced mild, non-bothersome paresthesia near the incision. Large fascia lata harvest offers a robust autograft for transvaginal or transabdominal POP repair with minimal morbidity. Harvest site complications are minor and typically resolve with expectant management. This technique can be safely utilized in patients who desire graft-augmented repair of POP without the use of synthetic mesh, allograft, or xenograft.

Fascia Lata Autografts Achieve Interface Healing With the Supraspinatus Muscle Histologically and Mechanically in a Rat Supraspinatus Tendon Reconstruction Model for Massive Irreparable Rotator Cuff Tears

PurposeTo evaluate the histologic healing process and mechanical characteristics of the interface between a fascia lata autograft and supraspinatus muscle by establishing a supraspinatus tendon reconstruction model for chronic massive, irreparable rotator cuff tears (MIRCTs). MethodsA total of 40 rats were studied. Eight rats were sacrificed to establish an intact control group, and the other rats were first established as the chronic MIRCTs model and then developed as the supraspinatus tendon reconstruction model. Histology, fatty infiltration, mechanics and the open field test for the interface between the fascia lata autograft and muscle were assessed at 2, 4, 8 and 16 weeks postoperatively. ResultsHistologically, the interface between the fascia lata autograft and muscle gradually regenerated structural similarities to the normal muscle-tendon interface by 16 weeks postoperatively. The amounts of collagen I and III were both increased significantly during the healing time and stabilized at 8 weeks postoperatively. Fatty infiltration was obvious in the supraspinatus muscle 4 weeks after the MIRCTs model. However, the degree of fatty infiltration in the supraspinatus muscle gradually decreased after supraspinatus tendon reconstruction and stabilized at 8 weeks postoperatively. The ultimate failure force and the ultimate stress gradually increased from 2 to 16 weeks and reached the level of the intact control tendon at 16 weeks postoperatively (P=0.086). The movability of the forepaw returned to normal in the open field test (P=0.907). ConclusionsIn this rat supraspinatus tendon reconstruction model, fascia lata autografts showed good interface healing with the supraspinatus muscle, and fatty infiltration in the supraspinatus muscle was histologically decreased. The interface between the fascia lata autograft and muscle can sustain mechanical strength similar to the anatomical muscle–tendon interface. Clinical RelevanceThe supraspinatus tendon reconstruction technique using fascia lata autografts might be a good histological and biomechanical option for treating MIRCTs.

Clinical results of arthroscopically-assisted lower trapezius transfer using fascia lata autograft for posterior superior irreparable rotator cuff tear

BackgroundDifferent interpositional grafts have been proposed to connect between the lower trapezius tendon (LTT) to the humerus during LTT transfer. While studies often mention the successful use of Achilles tendon allograft, there is currently no literature reporting the clinical outcomes of utilizing fascia lata autograft (FLA) in LTT transfer. Therefore, the current study aims to evaluate the clinical and radiologic results of LTT using FLA for posterior superior irreparable rotator cuff tears (PSIRCTs) without arthritis. Patient and methodsThe present study constitutes a retrospective case series involving 22 patients, with a mean follow-up of 35.9 ± 15.9 months. Pain levels were gauged using the Visual Analog Scale (VAS), while shoulder function was comprehensively assessed through the Constant and ASES (American Shoulder and Elbow Society) scores. The evaluation of shoulder activities in daily living employed the ADLER (Activities of Daily Living Requiring Active External Rotation) score. Active ROM (Range of Motion) of all directions were obtained, radiologic assessments included key parameters such as AHD (Acromion Humeral Distance) and the Hamada grade. Finally, the integrity of the transferred LTT was evaluated, and a subgroup analysis was undertaken based on Tm trophicity. ResultsBy the final follow-up period, VAS, Constant, ASES, and ALDER demonstrated significant improvement. Active ROM significantly improved in (FE) forward elevation to 155° ± 29°, abduction (Abd) to 140° ± 32°, external rotation (ER) at 90° Abd to 68° ± 19°, and ER at the side to 39° ± 17°. AHD and Hamada grade showed no significant arthritic progression. Tm hypertrophy group experienced superior improvements in ER compared to that of the non-hypertrophy group. Complications included re-tear (n = 2), infection (n = 1) and donor-site morbidity (n = 1). ConclusionThe study highlighted promising clinical outcomes of LTT transfer using FLA, with no significant complications. Along with Achilles tendon allograft, FLA can be a safe and viable alternative interpositional graft choice.

Mid-Term Outcome of Superior Capsular Reconstruction Using Fascia Lata Autograft (At Least 6 mm in Thickness) Results in High Retear Rate and No Improvement in Muscle Strength

To report and evaluate clinical and radiologic outcomes of superior capsular reconstruction (SCR) using fascia lata autograft in patients with irreparable rotator cuff tears (IRCTs) over a mid-term duration and to assess the overall survival rate of the graft. We retrospectively reviewed patients who underwent SCR with fascia lata autograft between June 2017 and August 2018. The graft, folded 3 or 4 times, achieved a minimum thickness of 6 mm during the surgical procedure. The inclusion criteria encompassed patients with isolated supraspinatus IRCTs or posterosuperior IRCTs exhibiting poor muscle quality (Goutallier grade ≥3) and without arthritis (Hamada grade ≤ 2). The exclusion criteria included lack of follow-up data or magnetic resonance imaging. Clinical assessments included the visual analog scale score, Constant score, and American Shoulder and Elbow Surgeons (ASES) score; active range of motion; and strength. Radiographic analysis included the acromiohumeral distance, Hamada grade, and graft integrity at final follow-up. A Kaplan-Meier curve was generated to depict SCR graft survivorship. In total, 45 patients (mean age, 64.8 ± 5.7 years) were included, and the average follow-up duration was 63.2 ± 5.9 months (range, 50-79 months). There was significant improvement in pain (visual analog scale score of 4.4 ± 1.3 preoperatively vs 1.4 ± 0.4 at final follow-up, P < .001). Yet, 18 patients (40.0%) and 17 patients (37.7%) achieved the minimal clinically important difference in the ASES score and Constant score, respectively. Active forward elevation increased from 119° ± 23° to 137° ± 23° (P < .001), and external rotation at the side improved from 29° ± 11° to 36° ± 12° (P= .002). However, strength did not exhibit improvement in any direction. The acromiohumeral distance decreased from 8.5 ± 1.7 mm to 6.5 ± 1.9 mm (P < .001), and the Hamada grade increased from 1.1 ± 0.3 to 1.8 ± 1.1 (P < .001). Finally, the infection rate was 13.3% (n= 6). Despite a substantial graft retear rate of 62.2%, SCR led to a significant improvement in pain. Nonetheless, 18 patients (40.0%) and 17 patients (37.7%) achieved the minimal clinically important difference in the ASES score and Constant score, respectively. Forward elevation and external rotation at the side showed significant improvement, but no improvement in muscle strength was observed. Finally, significant arthritis progression was observed. Level IV, retrospective case series.

Interposition Grafting Using Fascia Lata Autograft for Failed Rotator Cuff Repairs

Massive rotator cuff tears are a huge challenge for orthopaedic surgeons, as the patients may be in need of multiple operations, even including reverse total shoulder arthroplasty. The various repair methods for the rotator cuff, such as partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and superior capsular reconstruction, have always been the focus of research. During surgical intervention for failed rotator cuff repairs, complexity of tears, poor tissue quality, retained hardware, and adhesions are the problems routinely encountered. In this Technical Note, we describe the technique of interposition grafting using fascia lata autograft to reconstruct the rotator cuff after failed primary repair.

Acute Repair of Traumatic Lumbar Hernia with Fascia Lata Autograft

Acute Repair of Traumatic Lumbar Hernia with Fascia Lata Autograft

Bridging repair reinforced with artificial ligament as an internal brace for irreparable massive rotator cuff tears

BackgroundThe irreparable massive rotator cuff tear (IMRCT) is challenging to manage. Although various surgical options have been proposed to treat IMRCTs, the optimal surgical technique remains controversial. Arthroscopic bridging patch repair is clinically used for treating IMRCTs，but the healing rate of the patch graft is negatively affected by superior shift of the humeral head. This study aimed to evaluate the clinical efficacy of artificial ligament as an internal brace (IB) reinforcing fascia lata autograft bridging repair (ABR) in the treatment of IMRCTs. MethodsThe data of 50 patients with IMRCTs who underwent ABR reinforced with artificial ligament as an IB (ABR + IB) (internal brace group) or ABR alone (control group) were retrospectively evaluated preoperatively and at 2-year follow-up. Clinical outcomes were assessed based on the shoulder activity, of which the strength was measured using a 0-10 points manual muscle test scale, American Shoulder and Elbow Surgeons (ASES) Score, and visual analog scale (VAS) for pain. Imaging outcomes were evaluated based on acromiohumeral distance (AHD), Hamada grade, Goutallier grade, and the status of fascia lata grafts according to radiographs or magnetic resonance imaging findings. ResultsBoth groups showed significantly better results in shoulder activity, ASES score, VAS, and AHD at 2-year follow-up compared with preoperative levels (P < 0.001). Compared with the control group (n = 24), the internal brace group (n = 26) had better mean AHD (7.0 ± 1.4 mm versus 5.9 ± 1.0 mm, P = 0.002), mean improvement in AHD (3.3 ± 1.5 mm versus 2.0 ± 0.6 mm, P < 0.001), healing rate of autografts (92.3% versus 54.2%, P = 0.002), and improvement rate of Hamada grade (73.1% versus 41.7%, P = 0.025) at 2-year follow-up. No significant differences were found in active elevation, active external rotation, active internal rotation, abduction strength, external rotation strength, internal rotation strength, ASES score, or VAS between the two groups at 2-year follow-up ConclusionBoth the ABR + IB and ABR improved the postoperative short-term clinical and imaging outcomes in managing IMRCTs, the ABR + IB is statistically superior to ABR alone in terms of healing rate of the bridging graft, AHD, and Hamada grade at 2-year follow-up, while further clinical investigations with larger sample size and longer follow-ups are required to validate the clinical significance of this novel technique for IMRCTs.

Arthroscopic-Assisted Lower Trapezius Tendon Transfer Using a Fasciae Lata Autograft in Treatment of Posterior Superior Irreparable Rotator Cuff Tears in Lateral Decubitus Position

The optimal treatment for patients with posterior superior irreparable rotator cuff tears (PSIRCTs) is still a topic of ongoing debate. Lower trapezius tendon transfer is one of the effective surgical treatments for PSIRCTs in younger patients and elderly patients with high activity levels without arthritis. In this report, we describe an arthroscopic-assisted technique for lower trapezius transfer using a fascia lata autograft for patient with PSIRCTs in lateral decubitus position.

Prospective Outcomes of a Biological Resurfacing Arthroplasty with Fascia Lata Autograft (BioJoint) for the Treatment of Osteoarthritis of the Midtarsal Joint Complex.

To determine the clinical, safety, and radiological outcomes after biological resurfacing arthroplasty for the treatment of osteoarthritis (OA) of one or more joints of the midtarsal joint complex. All prospectively followed patients with OA to one of or multiple joints of the midtarsal joint complex who were operated with a biological resurfacing arthroplasty with a fascia lata autograft (BioJoint procedure) were included. A total of 7 patients were included (5 males, 2 females), with a median age of 52 (interquartile range [IQR] 44-55) years. The primary outcome was the Numeric Rating Scale (NRS) for pain during walking 2 years postoperatively. Range of motion (ROM), revision rates, and complications were assessed. A postoperative MRI scan was performed to assess progression of OA, graft position and ingrowth, and the degree of bone marrow edema. There was a 100% follow-up of the patients (median follow-up: 33 [IQR 26-33] months). The NRS during walking improved from 6 preoperatively to 2 at 2 years postoperatively (P < 0.05). There were no reoperations nor severe complications. The limitations in the ROM remained limited in the majority of the cases. MRI at 2 years of follow-up showed no progression of OA, reduced bone marrow edema, and no loosening of the grafts. Biological resurfacing arthroplasty with a fascia lata autograft (BioJoint procedure) for OA to one or more joints in the midtarsal joint complex showed clinically relevant pain reduction during walking, improvement in clinical and radiological outcomes, and proved to be safe and durable.

Mini-Open Fascia Lata Interposition Graft Results In Superior 2-Year Clinical Outcomes When Compared to Arthroscopic Partial Repair for Irreparable Rotator Cuff Tear: A Single-Blind Randomized Controlled Trial

To evaluate and compare the results of surgical treatment for irreparable rotator cuff tear (IRCT) by the mini-open interposition procedure using fascia lata autograft against outcomes of the arthroscopic partial repair technique. An interventional, prospective, controlled, randomized, single-blinded study involving 2 study groups was conducted. The graft group (n= 20) underwent the mini-open interposition procedure using fascia lata autograft. The control group (n= 22) underwent arthroscopic partial repair. Patients were evaluated using the University of California Los Angeles (UCLA) Shoulder scale, the American Shoulder and Elbow Surgeons (ASES) score, the Constant-Murley (Constant) score, the visual analogue scale (VAS) pain score, active range of motion, frontal flexion strength, retear rates evaluated by magnetic resonance imaging analysis, occurrence of complications, and the minimal clinically important difference (MCID). The graft group had better UCLA (31.5 vs 28.18, P= .035) (100% exceeded the MCID for the graft group and 95% for the control group), ASES (88.62 vs 77.06, P= .016) (100% exceeded the MCID for both groups), Constant (78.85 vs 61.68, P < .001), and VAS (0.95 vs 2.59, P= .01) scores at the 24-month follow-up. For active forward elevation range, both groups showed no statistically significant differences (168.5 vs 164.54, P= .538). The results for active external and internal rotation were better in the graft group (60.25 vs 40, and 9.1 vs 6.9, P < .001), as was frontal flexion strength (4.24 vs 2.67, P= .005). The graft group also had lower retear rates (15% vs 45.5%, P= .033). No complications were reported. Outcomes of surgeries for IRCT by the mini-open interposition procedure using fascia lata autograft and by the arthroscopic partial repair technique showed good results in both groups over time and exceeded the MCID. However, most comparative outcomes between groups showed better results for the interposition procedure. Level I, randomized controlled trial.

Postoperative graft integrity affects clinical outcomes after superior capsule reconstruction using fascia lata autograft in posterior-superior rotator cuff tears: a multicenter study.

Previous studies have postulated that graft thickness and graft healing may be important factors for optimizing clinical outcomes of superior capsule reconstruction (SCR) for patients with irreparable rotator cuff tears (RCTs). However, the relationship between postoperative graft integrity and clinical outcomes after SCR remains unclear. We aimed to assess the relationship between postoperative graft integrity, including graft thickness and size of graft tear, and clinical outcomes after SCR in patients with irreparable RCTs. This retrospective multicenter study included 188 patients (86 women, 102 men; mean age, 69.2years; range, 49-87years) with irreparable RCTs who underwent arthroscopic SCR using fascia lata autografts. Using magnetic resonance imaging, the graft integrity was evaluated postoperatively at or after 1year and was classified, according to Hasegawa's classification, into 4 categories: type I-II, intact graft of sufficient thickness; type III, thinned graft without discontinuity; type IV, presence of a minor discontinuity; and type V, presence of a major discontinuity. We compared (1) baseline characteristics, (2) visual analog scale (VAS) for pain, (3) American Shoulder and Elbow Surgeons (ASES) score, (4) active shoulder range of motion, and (5) acromiohumeral distance (AHD) among 4 groups based on postoperative graft integrity. Magnetic resonance imaging scans revealed 152 shoulders (80.9%) with type I-II graft, 13 (6.9%) with type III graft, 13 (6.9%) with type IV graft, and 10 (5.3%) with type V graft. VAS and ASES scores significantly improved after SCR in all graft types (P<.0001 to P=.02). However, shoulders with type V grafts had significantly inferior postoperative VAS and ASES scores compared to those with type I-II grafts (P=.001 and P<.0001, respectively). Shoulders without graft tears (types I-II and III) showed significant improvements in shoulder elevation and internal rotation after SCR (P<.0001 to P=.02). In contrast, shoulders with large graft tears (type V) showed no significant improvement in shoulder range of motion. Postoperative acromiohumeral distance significantly increased only in shoulders with type I-II grafts (P<.0001). Postoperative graft thickness and size of graft tear affected clinical and radiographic outcomes after SCR using a fascia lata autograft. Patients with large graft tears had significantly inferior postoperative clinical scores compared to those with intact grafts of sufficient thickness, although arthroscopic SCR provided pain relief even in patients with graft tears. Shoulders with intact grafts of sufficient thickness restored glenohumeral stability and showed better clinical outcomes than those with graft thinning or tears.

Clinical and Radiological Outcomes of Arthroscopic Superior Capsular Reconstruction Versus Primary Rotator Cuff Repair in Massive Rotator Cuff Tears: A Propensity Score–Matched Study

Background: Arthroscopic superior capsular reconstruction (aSCR) has emerged as a treatment option for managing massive rotator cuff tears (MRCTs) given the unpredictable results after an arthroscopic rotator cuff repair (aRCR). Yet, few comparative studies of aSCR and aRCR have been conducted. Purpose: To compare the clinical and radiological outcomes between aRCR and aSCR in patients with MRCT. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 163 cases of MRCT from 2010 to 2020 with follow-up ≥2 years were retrospectively reviewed. Among them, 102 had aRCR and 61 had aSCR using fascia lata autograft. Propensity score matching was used to select controls matched for age, sex, diabetes mellitus, osteoporosis, preoperative American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, Constant score, pain visual analog scale (pVAS) score, range of motion (ROM), tear size, global fatty degeneration index, and acromiohumeral distance (AHD). Last, 33 cases in each group were selected after propensity score matching. Radiological assessment was conducted using serial postoperative magnetic resonance imaging. Pre- and postoperative findings—including American Shoulder and Elbow Surgeons, pVAS, Single Assessment Numeric Evaluation, and Constant scores and ROM—were assessed to compare clinical outcomes. For radiological outcomes, global fatty degeneration index, AHD, and healing rate were evaluated. Healing failure was defined as Sugaya classification IV or V in the aRCR group, as compared with a full-thickness tear of the graft in the aSCR group, which corresponded to Sugaya classification IV or V. Results: Postoperative clinical outcomes were significantly improved at the final follow-up in both groups. In the aSCR group, postoperative forward flexion, pVAS, and AHD were significantly improved as compared with the aRCR group (mean, 161° vs 148° [P = .02]; 1.03 vs 1.64 [P = .047]; 7.00 vs 5.23 mm [P < .001], respectively). The healing rate was 20 of 33 (60.6%) for aRCR and 29 of 33 (87.9%) for aSCR (P = .022). Conclusion: aSCR and aRCR are effective and reliable treatment options for MRCT. However, when compared with aRCR, aSCR showed improved clinical outcomes, including pVAS score, postoperative ROM, and favorable radiological findings, including AHD and a higher healing rate.

Histopathological and Biomechanical Comparison of Patellar Tendon and Tensor Fascia Lata Autografts in Superior Capsular Reconstruction Surgery

Histopathological and Biomechanical Comparison of Patellar Tendon and Tensor Fascia Lata Autografts in Superior Capsular Reconstruction Surgery

Superior capsular reconstruction: current evidence and limits.

The treatment of rotator cuff tears (RCTs) has evolved. Nonsurgical treatment is adequate for many patients; however, for those for whom surgical treatment is indicated, rotator cuff repair provides reliable pain relief and good functional results. However, massive and irreparable RCTs are a significant challenge for both patients and surgeons. Superior capsular reconstruction (SCR) has become increasingly popular in recent years. It works by passively restoring the superior restriction of the humeral head, thus restoring the pair of forces and improving the kinematics of the glenohumeral joint. Early clinical results using fascia lata (FL) autograft were promising in terms of pain relief and function. The procedure has evolved, and some authors have suggested that FL autografts could be replaced by other methods. However, surgical techniques for SCR are highly variable, and patient indications remain undefined. There are concerns that the available scientific evidence does not support the popularity of the procedure. This review aimed to critically evaluate the biomechanics, indications, procedural considerations, and clinical outcomes associated with the SCR procedure.

Graft and Flap: Orthoplastic Approach to Achilles Tendon Secondary Rupture.

Achilles tendon rupture represents one of the most common tendon ruptures. Although primary repair remains the treatment of choice, surgical complications, such as secondary rupture and tendon exposure, require salvage procedures. This article aims to present the authors' orthoplastic approach for the functional reconstruction of composite secondary Achilles tendon defects. Seven patients with chronic open-wound and large Achilles tendon defects (Kuwada type IV) underwent one-stage reconstruction between October of 2018 and October of 2020. The size of the average soft-tissue defect was 126.2 cm 2 (range, 86.1 to 175.9 cm 2 ), with a tendon gap of 8.2 cm (range, 7.1 to 10.3 cm). A combined team of orthoplastic surgeons performed the reconstructive procedure, using a turndown gastrocnemius fascial flap and a fascia lata autograft for the tendon reconstruction and a free fasciocutaneous anterolateral thigh flap for soft-tissue coverage (graft and flap). Subjective evaluation and quality-of-life measures were obtained preoperatively and 12 months postoperatively using the American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey questionnaire. Mean follow-up was 18.3 months (range, 12 to 24 months). The flap survival rate was 100%. Overall range of motion of the reconstructed side was 87% of the unaffected side (54 degrees versus 62 degrees). The American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey scores of all patients improved significantly ( P < 0.005) at 12 months of follow-up. A microsurgical approach combined with orthopedic techniques can solve complex cases of Achilles tendon secondary rupture, providing a reconstructed tendon that achieves satisfactory anatomic shape and function. Therapeutic, IV.

Quel est l’impact des traitements hormonaux féminins sur le système cardiovasculaire ?

To systematically review and report the mid- to long-term patient reported outcomes (PROs) following hip labral reconstruction.A literature search of the Pubmed, Embase, and Cochrane Library databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for clinical studies reporting mid- to long-term PROs at minimum five year follow-up following arthroscopic hip labral reconstruction. A quality assessment was performed using the Methodological Index of Non-Randomized Studies (MINORS) grading system. Data collection included study characteristics, demographics, indications, radiographic metrics, perioperative findings, surgical technique, baseline and most recent PROs, and subsequent surgeries.Four studies met inclusion criteria, with 182 hips (age range, 27.9 to 38.7 years) undergoing labral reconstruction in primary and revision hip surgery with minimum five year follow-up. There were three level III studies and one level IV study, with an average MINORS score of 16.6. All studies cited labral tissue characteristics as a factor for surgical indications, including the quality and/or size of the labrum. Three studies performed segmental labral reconstructions, while another study utilized a circumferential technique. Varying grafts were selected, including hamstring autograft/allograft, ligamentum teres autograft, iliotibial band autograft, and tensor fascia lata autograft. All studies demonstrated improved PROs from baseline to most recent follow-up, with four studies reporting modified Harris Hip Score (mHHS) values that increased from baseline (range, 58.9 to 66.8) to most recent follow-up (range, 80.1 to 86.3). After labral reconstruction, rates of revision arthroscopy ranged from 4.8% to 13.3% and conversion to total hip arthroplasty ranged from 1.6% to 27%.Improved PROs were observed in all studies at minimum 5-year follow-up, suggesting that labral reconstruction can offer durable results beyond short-term follow-up. While surgical indications for all studies included labral tissue characteristics, differing graft selection and surgical techniques were utilized across studies, limiting the ability to determine an optimal treatment approach.

Arthroscopic Superior Capsule Reconstruction With Combined Fascia Lata Autograft and Synthetic Scaffold Patch Graft for the Treatment of Irreparable Rotator Cuff Tears Yields Favorable Clinical and Radiographic Outcomes at Minimum 2-Year Follow-Up

To report the results of the arthroscopic superior capsule reconstruction (ASCR) technique with a combined fascia lata autograft and synthetic scaffold patch graft for irreparable massive rotator cuff tears (RCTs). The period for this retrospective study was between December 2016 and December 2020. The criteria for inclusion were patients treated arthroscopically for an incompletely repaired massive RCT (dimension >5 cm and 2 tendons fully torn, intact or reparable subscapularis tendons and teres minor tendon with or without irreparable infraspinatus, a radiological Hamada classification between grade 0 and 4, and a minimum 24-month postoperative follow-up). Clinical outcomes were evaluated preoperatively and at a final follow-up by a visual analog scale (VAS) for pain and range of motion along with the American Shoulder and Elbow Surgeons score (ASES), the University of California Los Angeles score (UCLA), and the Constant-Murley score (CMS). Radiological outcomes were assessed, according to the rotator cuff arthropathy (RCA) and the acromiohumeral distance (AHD) stages. Graft integrity and muscle fatty infiltration were evaluated by magnetic resonance imaging (MRI). A total of 43 patients were enrolled in the study with a mean follow-up duration of 45.6 months (range: 24 to 64). All clinical scores also improved at the 2-year follow-up (mean: VAS 0.7 [SD 0.7] vs 5.4 [SD 1.1]; P < .001; mean: ASES 92.6 [SD 8.0] vs 34.8 [SD 13.4]; P < .001; mean UCLA 31.5 [SD 3.9] vs 11.0 [SD 3.2]; P < .001; and mean CMS 86.6 [SD 7.2] vs 40.0 [SD 11.6]; P < .001), and 39 of 43 fascia lata grafts were fully intact on MRI (91%). ASCR with a combined fascia lata autograft and synthetic scaffold patch graft resulted in good functional outcomes, with a high rate of graft healing at the 2-year follow-up. All patients achieved clinically relevant improvement (met minimal clinically important differences [MCID]) on ASES, UCLA, and VAS with improved abduction strength restoration. Level IV, retrospective case series.