Arthroscopic superior capsular reconstruction with a mesh augmentation improves superior shoulder joint stability, according to a new study.
Mesh Augmentation Improves Stability After Rotator Cuff Tear
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#rotatorcufftearSecondary#pain#meshaugmentation
In the study, “Arthroscopic Superior Capsular Reconstruction With Mesh Augmentation for the Treatment of Irreparable Rotator Cuff Tears: A Comparative Study of Surgical Outcomes,” published in The American Journal of Sports Medicine, researchers evaluated the benefits of mesh augmentation in the treatment of irreparable rotator cuff tears.
Arthroscopic superior reconstruction has become a popular alternative to open surgery for irreparable chronic rotator cuff tears, but little is known about graft tears’ effect on clinical outcomes after the procedure.
The study included 64 patients with irreparable rotator cuff tears who underwent arthroscopic superior capsular reconstruction between 2013 and 2018. Thirty patients were given fascia lata grafts augmented with a polypropylene mesh and 34 patients received grafts without mesh augmentation.
Clinical and radiological outcomes were assessed preoperatively and at final follow-up. They included the American Shoulder and Elbow Surgeons questionnaire, Visual Analog Scale for pain, acromiohumeral distance and stage of rotator cuff arthropathy. The status of fatty infiltration and graft integrity was evaluated using magnetic resonance imaging.
Overall, both groups showed improvements in clinical and radiological outcomes. The mesh group, however, had a larger improvement in American Shoulder and Elbow Surgeons score (mean ±SD, 29.1 ±15.8) than the control group (18.1 ±15.9; p = .006).
The mesh group also had significant improvements in active forward flexion, active external rotation and graft healing than the control group.
Acromiohumeral distance was also greater in the mesh group (9.1 ±2.4 mm) than in the control group (6.3 ±1.8 mm) at the final follow-up.
The researchers wrote, “Subgroup analysis revealed that patients with graft failure generally showed progression of fatty infiltration without improvement in the stage of rotator cuff arthroplasty demonstrated a more substantial improvement in functional outcomes.”
Arthroscopic superior reconstruction with mesh augmentation is effective at reducing graft failure, they concluded.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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