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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, irreparable rotator cuff tears (RCTs) are challenging to treat, especially in young and ac<ve pa<ents • Arthroscopic superior capsule reconstruc<on (ASCR) has been introduced as an alterna<ve to la<ssimus dorsi tendon transfer (LDTT) Purpose: • To compare short-term clinical outcomes following ASCR vs. LDTT for the treatment of massive, irreparable RCTs. Hypothesis: • Preliminary clinical outcomes for ASCR pa<ents will not significantly differ from those of LDTT pa<ents. • Retrospec<ve review of prospec<vely collected data, Level III • Inclusion criteria: ≥ 12 months s/p ASCR or LDTT for irreparable RCT • Failure defined as progression to reverse shoulder arthroplasty • Data collected: SF-12 PCS, SANE, QuickDASH, ASES score, post-opera<ve sa<sfac<on, acromiohumeral distance (AHD) Arthroscopic SCR: • 3mm acellular dermal allograU patch • 3 x 3.0mm knoXed suture anchors for glenoid-sided fixa<on • Knotless cross-linked double-row fixa<on laterally at the footprint • Mul<ple side-to-side sutures between allograU and infraspinatus tendon La6ssimus Dorsi Tendon Transfer: • AUer diagnos<c arthroscopy, the la<ssimus tendon is harvested and, if necessary, augmented with a 3mm human acellular dermal patch • The na<ve rotator cuff <ssue is repaired as much as possible, and the la<ssimus tendon is passed underneath the deltoid and posterior to the teres minor • The (patch-augmented) tendon is then integrated into a knotless cross-linked double-row repair with eight suture anchors • Pa<ents who underwent ASCR had significantly improved clinical outcome scores and improved range of mo<on at 12 months post-opera<vely. • Pa<ents who underwent LDTT showed an increase in postopera<ve outcomes scores that only reached significance in pain scores with no improvement in range of mo<on. Pogorzelski J, DelVecchio BM, Fritz EM, Hussain ZB, Godin JA, MilleX PJ. Superior capsule reconstruc<on for massive rotator cuff tears – key considera<ons for rehabilita<on. Int J Sports Phys Ther. February 2017, In Press. Mihata T, Lee TQ, Watanabe C et al. (2013) Clinical results of arthroscopic superior capsule reconstruc<on for irreparable rotator cuff tears. Arthroscopy 29:459-470 Petri M, Greenspoon JA, MilleX PJ (2015) Arthroscopic Superior Capsule Reconstruc<on for Irreparable Rotator Cuff Tears. Arthrosc Tech 4:e751-755 A B C D E Figure 1: (A) Arthroscopic view of a right shoulder demonstra<ng a massive, irreparable rotator cuff tear. (B) Arthroscopic view of the same shoulder demonstra<ng the completed ASCR. (C) Illustra<on of the SCR on a right shoulder. (D) Right shoulder showing augmented la<ssimus dorsi tendon. (E) Completed LDTT on a right shoulder. Figure 2: Flow chart demonstra<ng the pa<ent popula<on for this study aUer accoun<ng for inclusions, exclusions, clinical failures, and those lost to follow-up. Pa<ents progressing to RTSA were defined as failures. Mean age of pa<ents and amount of Workman’s Compensa<on were significantly different. RTP = refused to par<cipate. Figure 3: Four graphics presen<ng the postopera<ve results of the two groups. From leU to right: (1) Comparison of the pre- and postopera<ve outcomes (ASCR group); (2) ) Comparison of the pre- and postopera<ve outcomes (LDTT group); (3) Postopera<ve func<onal outcomes and AHD of both groups; (4) Comparison of the ASES Total Score of both groups over <me. • The most important finding of our study is that pa<ents who underwent ASCR had superior postopera<ve outcomes aUer 12 months compared to pa<ents who underwent LDTT, especially with regards to shoulder func<on. • However, longer follow-up is needed to confirm this trend. • Our study is not without limita<ons. First, pa<ents were non-randomized and had different follow-up lengths. Second, there were significantly more Worker‘s Compensa<on cases in the LDTT group, which is known to poten<ally have a nega<ve influence on postopera<ve outcomes. In addi<on, this is a small sample size.
