Introduction
Results
Arthroscopic Superior Capsule Reconstruction versus Latissimus Dorsi Tendon Transfer: A Comparison of Early Clinical Outcomes
Jonas Pogorzelski MD, MHBA, Marilee P. Horan MPH, Erik M. Fritz MD, J. Christoph Katthagen MD, Jonathan A. Godin MD, MBA, Peter J. Millett MD, MSc
Center for Outcomes-based Orthopaedic Research at the Steadman Philippon Research Institute, Vail, Colorado, USA
References
Discussion
Methods
• Massive,irreparablerotatorcufftears(RCTs)arechallengingtotreat,especiallyinyoungandac<vepa<ents
• Arthroscopicsuperiorcapsulereconstruc<on(ASCR)hasbeenintroducedasanalterna<vetola<ssimusdorsitendontransfer(LDTT)
Purpose:
• Tocompareshort-termclinicaloutcomesfollowingASCRvs.LDTTforthetreatmentofmassive,irreparableRCTs.
Hypothesis:
• PreliminaryclinicaloutcomesforASCRpa<entswillnotsignificantlydifferfromthoseofLDTTpa<ents.
• Retrospec<vereviewofprospec<velycollecteddata,LevelIII
• Inclusioncriteria:≥12monthss/pASCRorLDTTforirreparableRCT
• Failuredefinedasprogressiontoreverseshoulderarthroplasty
• Datacollected:SF-12PCS,SANE,QuickDASH,ASESscore,post-opera<vesa<sfac<on,acromiohumeraldistance(AHD)
ArthroscopicSCR:
• 3mmacellulardermalallograUpatch
• 3x3.0mmknoXedsutureanchorsforglenoid-sidedfixa<on
• Knotlesscross-linkeddouble-rowfixa<onlaterallyatthefootprint
• Mul<pleside-to-sidesuturesbetweenallograUandinfraspinatustendon
La6ssimusDorsiTendonTransfer:
• AUerdiagnos<carthroscopy,thela<ssimustendonisharvestedand,ifnecessary,augmentedwitha3mmhumanacellulardermalpatch
• Thena<verotatorcuff<ssueisrepairedasmuchaspossible,andthela<ssimustendonispassedunderneaththedeltoidandposteriortotheteresminor
• The(patch-augmented)tendonisthenintegratedintoaknotlesscross-linkeddouble-rowrepairwitheightsutureanchors
• Pa<entswhounderwentASCRhadsignificantlyimprovedclinicaloutcomescoresandimprovedrangeofmo<onat12monthspost-opera<vely.
• Pa<entswhounderwentLDTTshowedanincreaseinpostopera<veoutcomesscoresthatonlyreachedsignificanceinpainscoreswithnoimprovementinrangeofmo<on.
PogorzelskiJ,DelVecchioBM,FritzEM,HussainZB,GodinJA,MilleXPJ.Superiorcapsulereconstruc<onformassiverotatorcufftears–keyconsidera<onsforrehabilita<on.IntJSportsPhysTher.February2017,InPress.
MihataT,LeeTQ,WatanabeCetal.(2013)Clinicalresultsofarthroscopicsuperiorcapsulereconstruc<onforirreparablerotatorcufftears.Arthroscopy29:459-470
PetriM,GreenspoonJA,MilleXPJ(2015)ArthroscopicSuperiorCapsuleReconstruc<onforIrreparableRotatorCuffTears.ArthroscTech4:e751-755
A B C
D E
Figure1:(A)Arthroscopicviewofarightshoulderdemonstra<ngamassive,irreparablerotatorcufftear.(B)Arthroscopicviewofthesameshoulderdemonstra<ngthecompletedASCR.(C)Illustra<onoftheSCRonarightshoulder.(D)Rightshouldershowingaugmentedla<ssimusdorsitendon.(E)CompletedLDTTonarightshoulder.
Figure2:Flowchartdemonstra<ngthepa<entpopula<onforthisstudyaUeraccoun<ngforinclusions,exclusions,clinicalfailures,andthoselosttofollow-up.Pa<entsprogressingtoRTSAweredefinedasfailures.Meanageofpa<entsandamountofWorkman’sCompensa<onweresignificantlydifferent.RTP=refusedtopar<cipate.
Figure3:Fourgraphicspresen<ngthepostopera<veresultsofthetwogroups.FromleUtoright:(1)Comparisonofthepre-andpostopera<veoutcomes(ASCRgroup);(2))Comparisonofthepre-andpostopera<veoutcomes(LDTTgroup);(3)Postopera<vefunc<onaloutcomesandAHDofbothgroups;(4)ComparisonoftheASESTotalScoreofbothgroupsover<me.
• Themostimportantfindingofourstudyisthatpa<entswhounderwentASCRhadsuperiorpostopera<veoutcomesaUer12monthscomparedtopa<entswhounderwentLDTT,especiallywithregardstoshoulderfunc<on.
• However,longerfollow-upisneededtoconfirmthistrend.
• Ourstudyisnotwithoutlimita<ons.First,pa<entswerenon-randomizedandhaddifferentfollow-uplengths.Second,thereweresignificantlymoreWorker‘sCompensa<oncasesintheLDTTgroup,whichisknowntopoten<allyhaveanega<veinfluenceonpostopera<veoutcomes.Inaddi<on,thisisasmallsamplesize.