Achilles Tendon for Superior Capsular Reconstruction??

The use of an Achilles tendon-bone allograft for superior capsular reconstruction doesn’t improve failure rate after the procedure, according to a new study.

In the study, “Failure Rate After Superior Capsular Reconstruction With Achilles Tendon-Bone Allograft for Irreparable Rotator Cuff Tears,” published online on May 5, 2021 in the Orthopaedic Journal of Sports Medicine, the researchers wanted to evaluate the surgical outcomes of superior capsular reconstruction with Achilles tendon-bone allograft to see if it improved failure rates.

“Superior capsular reconstruction (SCR) is an alternative to reverse shoulder arthroplasty for irreparable rotator cuff tears (IRCTs). The reconstructed capsule acts as a static restraint to prevent superior migration of the humeral head. Traditional SCR uses a fascia lata autograft, which has shown failure at the greater tuberosity,” the researchers wrote.

The retrospective study included six patients with massive irreparable rotator cuff tears who underwent SCR using an Achilles tendon-bone allograft between January 2017 and January 2018.

The researchers evaluated clinical outcomes using range of motion, the American Shoulder and Elbow Surgeons score, and the visual analog scale for pain. They also measured acromiohumeral distance and the status of graft integrity using serial magnetic resonance imaging.  About six months after the surgery, a second-look arthroscopic procedure was performed to check graft integrity.

Mean follow-up was 14.5 months (range, 12-17 months). The American Shoulder and Elbow Surgeons and Visual Analog Scale scores improved from 42.8 ± 11.9 and 4.0 ± 1.2 to 62.1 ± 14.7 and 2.8 ± 1.4, respectively. Forward flexion and external rotation improved from 98° ± 36° and 58° ± 4° to 123° ± 20° and 39° ± 8°, respectively, and the acromiohumeral distance improved from 3.9 ± 0.8 mm to 6.4 ± 2.2 mm at final follow-up.

The researchers found that while clinical outcomes did improve, at the postoperative arthroscopic, there was a graft failure rate of 83.3%.

“SCR is still evolving from a surgical technique standpoint, with a wide variety of procedures being reported. To date, debate exists about whether a side-to-side graft repair to the adjacent remaining rotator cuff is necessary,” the researchers wrote.

“The side-to-side graft repair was performed with the premise of having complete restoration of shoulder stability, which was supported by a previous biomechanical study. Our study revealed that the side-to-side repair of the graft to the remnant native tissue had a high failure rate. Lee and Min described the side-to-side repair of the graft to the posterior remnant tissue in their retrospective series and showed that remnant tissue is mostly poor quality. Perhaps the cause of side-to-side repair failure of the SCR is associated with the poor quality of the native tissue.”