GRAFT TEARS AFTER SUPERIOR CAPSULAR RECONSTRUCTION WITH AUTOLOGOUS FASCIA LATA: AN EFFECT OF PRE- AND POSTOPERATIVE MOTOR FUNCTION

K. Kumashiro¹, K. Kitamoto¹, A. Shiraishi¹, K. Yamada¹

¹Kurashiki Central Hospital, Department of Rehabilitation, Kurashiki, Japan

Background: Arthroscopic superior capsular reconstruction (ASCR) with autologous fascia lata has been reported to have good outcomes in overcoming irreparable rotator cuff tears. However, graft tears after ASCR results in poor clinical outcomes. These post-ASCR graft tears have been reported to be affected by age, gender, preoperative Hamada classification and status of the subscapularis. However, the effect of pre- and postoperative motor function on graft tears remains unreported.

Purpose: The purpose of this study was to investigate the effect of preoperative and 3-month postoperative motor function on graft tears after ASCR with autologous fascia lata.

Methods: Twenty-nine patients who underwent ASCR with autologous fascia lata for irreparable rotator cuff tear between December 2016 and February 2020 were included for this study. Inclusion criteria comprised of patients whose graft status could be assessed postoperatively using MRI and motor function could be evaluated preoperatively and 3-months postoperatively. The included subjects were divided into two groups: with and without graft tears. Motor function assessment included active elevation angle, muscle strength (abduction, external rotation, and internal rotation), and VAS scoring for pain. The presence of preoperative pseudoparalysis was also evaluated, which was defined as active elevation angle of less than 90 degrees. Additionally, age, gender, preoperative Hamada classification, subscapularis status, ASES score, and active elevation angle at last follow-up were also evaluated. In a sub analysis, patients without preoperative pseudoparalysis were selected and divided in two groups, with and without graft tears, to investigate the characteristics of graft tears in patients without preoperative pseudoparalysis.

Results: The overall incidence of graft tears amongst the 29 participants in the study was found to be 24.1 %. Compared with the group without graft tears, the graft tears group had a higher percentage of no preoperative pseudoparalysis (P=0.051) and a greater preoperative active elevation angle (P=0.051). The graft tear group also had poor preoperative Hamada classification (P=0.031) and irreparable subscapularis (P=0.034), along with poor active elevation angle at final post-operative follow-up (P=0.026). Furthermore, among the patients without preoperative pseudoparalysis (n=11), those with irreparable subscapularis (P=0.061), those who exhibited less pain (P=0.05) and a better active elevation angle (P=0.054) at the 3-month post-operative follow up, were more prone to graft tears.

Conclusions: The present study suggests that the combination of preoperative progression of the Hamada classification and irreparable subscapularis along with the lack of preoperative pseudoparalysis, contributes to graft tears. Furthermore, patients without preoperative pseudoparalysis capable of active elevation early postoperatively were more likely to experience graft tears.

Implications: In early post-ASCR with autologous fascia lata, it is important to implement physiotherapy that takes into account the characteristics of the shoulder joint during active elevation. Shoulder joint elevation should be modified to allow stable fulcrum motion, especially in patients with high risk of graft tears.

Keywords:
Superior capsular reconstruction
Graft tear
Motor function

Topics:
Orthopaedics
Musculoskeletal: upper limb

Did this work require ethics approval? Yes

Institution: Kurashiki Central Hospital

Committee: Clinical Research Review Committee

Ethics number: Clinical research application No. 3887