Arthroscopic Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears with Autologous Fascia Lata Graft

Summary

This protocol outlines the steps for superior capsule reconstruction with fascia lata autograft, aiming to restore shoulder stability and function in patients with irreparable rotator cuff tears, followed by structured postoperative rehabilitation for optimal healing.

Abstract

This study explores the efficacy of superior capsule reconstruction (SCR) using fascia lata autograft for treating irreparable rotator cuff tears. Based on our experience and existing literature, SCR has demonstrated promising outcomes, offering improved shoulder stability, reduced pain, and prevention of humeral head migration. Patients undergoing SCR with fascia lata autograft achieved near-normal shoulder range of motion postoperatively, with maintained acromio-humeral distance observed in radiographic follow-ups. Various graft modifications, including the use of dermal grafts and the long head of the biceps tendon, have been explored. Yet, studies indicate the superior thickness and tensile strength of fascia lata autograft supports more durable outcomes. The SCR protocol detailed in this study includes meticulous graft harvesting, arthroscopic examination, and precise graft placement with suture anchors to ensure stability. Postoperative care involves immobilization followed by gradual rehabilitation, promoting effective healing and functional recovery. This approach highlights SCR's potential as a valuable treatment for active patients with irreparable rotator cuff tears.

Introduction

Despite advancements in medical science, a definitive gold standard for the treatment of massive irreparable rotator cuff tears has yet to be established. Historically, several treatment options have been attempted, including debridement, partial repair, and conservative management^1,2,3,4. In recent years, numerous innovative surgical techniques have been introduced and have demonstrated favorable short-term outcomes^3,5,6,

Protocol

This protocol was approved by the Institutional Review Board of the Chang Gung Medical Foundation (IRB No. 202000604B0), and informed consent was obtained from all participants.

1. Harvesting the Tensor Fascia Lata autograft

1. Under general anesthesia, place the patient initially placed in the lateral decubitus position to facilitate graft harvesting.
2. After standard sterile preparation of the skin with povidone-iodine solution and sterile draping of the operative field, make a longitudinal single incision approximately 8 cm in length over the proximal lateral thigh, centered over the tensor fascia lata, using a No. 10 sc....

Results

At 1 year postoperatively, patients who underwent SCR using the aforementioned technique demonstrated near-normal recovery of shoulder joint range of motion, including forward flexion, external rotation, and internal rotation (Figure 4A). Radiographic follow-up at the same time point showed that the acromiohumeral distance (AHD) was also well-maintained. (Figure 4B).

Discussion

Since its introduction by Mihata et al. in 2013, SCR has undergone various developments, particularly in selecting graft materials, which have seen significant variation. This is likely one of the reasons for the inconsistent clinical outcomes observed in previous literature regarding SCR²⁰. Previous studies by Mihata have demonstrated that using a fascia lata autograft provides significant biomechanical benefits in preventing superior migration of the humeral head and reducing subacromial contact.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Footprint knotless PEEK suture anchor	Smith & Nephew, Andover, MA		Two 4.5 mm anchors for lateral row fixation over humeral site
Glenoid and humerus anchors	Stryker	Iconix	All-suture anchor
Iconix suture anchor	Stryker Endoscopy, San Jose, CA		Two 2.3 mm anchors for glenoid site and two 2.3 mm anchors for medial row fixation over humeral site
Lateral row anchor	Smith & Nephew	Footprint Ultra	For Future-bridge repair