Superior capsule reconstruction for irreparable rotator cuff tear with a porcine dermal graft: Preliminary results at 2 years minimum follow-up

Abstract

Purpose. Currently, no consensus has been achieved regarding treatment of irreparable and massive rotator cuff tears. The purpose of this study was to evaluate clinical outcomes and acromiohumeral distance after superior capsular reconstruction, using a porcine dermal graft. Methods. In this study, patients underwent arthroscopic superior capsule reconstruction were included. Grafts used a porcine dermal matrix. Main inclusion criterion was a symptomatic massive, irreparable supraspinatus tear. Patients were excluded for severe shoulder osteoarthritis or important fatty degeneration or shoulder stiffness. Constant score, VAS, ASES and complications were assessed preoperatively and at last follow-up. Acromiohumeral distance was measured using X-ray. Results. Among the 23 patients enrolled, mean age was 60,5years (±3). Mean follow-up was 29,3months (±3,7). Mean Constant score improved from 34,7 (±7,8) to 78,3 (±16,5),p=2.81E-13. At last follow-up, mean forward flexion increased to 126° (±33°,p=9.05E-12), muscle strength (points/25) increased to 15.3 (±5.6,p=0.56). Mean ASES increased from 38,2 ±4.3 to 81 ±14,1 at last follow-up (p=6.48E-16). VAS had decreased to 1.4 (±1.9) from a mean of 4,8 (±1.3),p=1.68E-07. Acromiohumeral distance increased from 6.6mm ±1.2 to 8.7mm ±1,p=3.11E-07. At last follow up, major complications included 5 revisions (21%), 2 latissimus dorsi transfer and 3 reversed shoulder arthoplasty. Neither rejection nor sepsis were observed. Conclusions. In this preliminary study of superior capsule reconstruction with a porcine dermal matrix xenograft, improvements in shoulder outcomes were showed. Despite a high rate of revisions and potential confounding factors, superior capsule reconstruction with such porcine graft may be an effective treatment to re-centring the humeral head with respect to the glenoid on this selective population.