Whether the proximal edge of the graft is attached on the glenoid bone or to the torn tendon during arthroscopic reconstruction of irreparable rotator cuff tear, whichever direction a surgeon chooses will not affect short-term clinical and radiographic outcome, researchers say in a new paper.
Graft Attachment to Glenoid Bone or Torn Tendon?
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The study, “Graft Healing is More Important than Graft Technique: Superior Capsular Reconstruction Versus Bridging Grafts-A Prospective Randomized Controlled Trial,” was published online July 11, 2022 in the journal Arthroscopy.
In the study, the researchers compare superior capsular reconstruction to bridging graft for cases of massive, irreparable rotator cuff tears.
Fifty patients with chronic tears were included in a prospective double-blind randomized study. Their mean age was 60.2 +/- 6.0 years). The mean duration of symptoms was about five years. All patients underwent partial repair to superior capsular reconstruction or bridging graft using human dermal allograft, and then standardized rehabilitation.
The research team was able to collect two-year follow up data for 46 patients. The team measured outcomes using mean ASES, WORC, and QuickDASH scores. At two years, the scores were 74.8 +/- 23.9, 66.0 +/- 28.3, and 24.7 +/- 26.1, respectively, for the superior capsular reconstruction group, and 77.9 +/- 19.9, 69.5 +/- 24.5, and 25.0 +/- 19.1, respectively, for the bridging graft group with no significant difference between groups.
In addition, 18 of 24 in the superior capsular reconstruction group and 14 of 22 in the bridging graft group were intact at 12 months (p = 0.53). Overall, patients with intact grafts compared to those with retorn grafts, whether superior capsular reconstruction or bridging graft, had higher ASES and WORC scores at 24 months (ASES 81.0±18.7 vs 65.7±24.4, p=0.021 and WORC 72.3±24.6 vs 53.7±26.7, p = 0.04) and higher acromiohumeral intervals on radiographs at all follow-up time points.
“When performing arthroscopic reconstruction using human dermal allograft for an irreparable rotator cuff tear, whether the proximal edge of the graft is attached on the glenoid bone or to the torn tendon does not significantly change short-term clinical and radiographic outcomes,” the researchers wrote.
Study authors included Yohei Ono, M.D., Ph.D., Justin LeBlanc, M.D., M.Sc., FRCSC, Aaron J. Bois, M.D., M.Sc., FRCSC, Saho Tsuchiya, M.D., Tanujan Thangarajah, MB ChB(hons), MSc, PhD FRCS, all of the McCaig Institute for Bone and Joint Health University of Calgary, Calgary, Alberta, Canada. Kristie D. More, M.Sc., of Sport Medicine Centre, University of Calgary, Calgary, Alberta, Canada; and Ian K.Y. Lo. M.D., FRCSC of Department of Surgery, University of Calgary, Calgary, Alberta, Canada, also contributed to the study.
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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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