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.