Autograft or Allograft for Superior Capsule Reconstruction?

Which do you prefer, autograft or allograft for superior capsule reconstruction? Is there a difference in terms of range of motion?

Using 8 fresh-frozen cadaveric shoulders, a University of Chicago research team compared two grafts—one autograft, the other human dermal allograft—with and without posterior side-to-side suturing for superior capsule reconstruction.

The results of their work, “Long Head of the Biceps Autograft performs biomechanically similar to Human Dermal Allograft for Superior Capsule Reconstruction after Rotator Cuff Tear,” was published online on November 14, 2022, in the journal Arthroscopy.

Each of the cadaveric shoulders were tested under 5 conditions:

1. intact,
2. complete supraspinatus tear,
3. long head of biceps tendon autograft,
4. long head of biceps tendon autograft with side-to-side suturing and
5. human dermal allograft with side-to-side suturing.

The researchers then tested each shoulder for:

1. functional abduction force,
2. superior translation of humeral head,
3. translational range of motion and
4. rotational range of motion at 0°, 30°, 60°, and 90° of abduction within each condition.

The resulting data provided evidence that functional abduction force in the long head of biceps autograft and the long head of biceps and suture, and the human dermal allograft and suture conditions was significantly increased compared with the supraspinatus tear conduction at abduction angles of:

1. 30° (p = 0.011, 0.001, and 0.017 respectively),
2. 60° (p = 0.004, 0.001, and 0.002 respectively), and
3. 90° (p = 0.013, 0.011, and 0.038 respectively).

The superior translation of the humeral head in the long head of biceps and human dermal allograft groups both with and without side-to-side suturing also significantly decreased compared to the tear condition.

The researcher team concluded that all three reconstructive techniques were identical to the intact rotator cuff condition in terms of range of motion.

“Superior capsule reconstruction with long head of biceps tendon autograft and human dermal allograft both restore functional abduction force and decrease superior translation of the humeral head, while displaying no losses in the range of motion in a cadaveric model,” they wrote.

Study authors include Pranav Krishnan, B.A., Nicholas Maaseen, M.D., Cody Lee, M.D., Hayden Baker, M.D., and Aravind Athiviraham, M.D., all from the University of Chicago in Chicago, Illinois.

Jason Koh, M.D. and Farid Amirouche, Ph.D., both from Northshore University Health System in Chicago, Illinois, also contributed to the research.