Using a fascia lata graft for superior capsule reconstruction offers positive patient outcomes, according to a new study.
Fascia Lata Good Graft for Superior Capsule Reconstruction
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The study, “Superior Capsule Reconstruction With Fascia Lata Allograft Has Initial Stiffness and Ultimate Load Comparable to the Native Shoulder Superior Capsule: A Cadaveric Biomechanical Study,” was published online in the January 1, 2023 issue of the journal Arthroscopy.
For their study, the Congress Medical Foundation and Keck School of Medicine teams compared the biomechanical characteristics of a fascia lata superior capsule reconstruction to the native superior capsule.
The two research groups first tested the native superior capsule of eight cadaveric shoulders with cyclic loading from 10 to 50 N for 30 cycles in 20° of glenohumeral abduction followed by load to failure at 60 mm/min. Afterwards, they performed fascia lata superior capsule reconstruction on the shoulders.
They then documented that the stiffness for cycle 1 to 50 N was higher for the native superior capsule versus the fascia lata superior capsule reconstruction (p = .001). However, by cycle 30, the stiffness between the two was not statistically different.
Overall, the linear stiffness and yield load of the native superior capsule were significantly greater than that of the fascia lata superior capsule reconstruction (94.5 vs 28.0 N/mm, p = .013: 386.9 vs 123.8 N, p = .029). The researchers discovered no significant difference in ultimate load between the native superior capsule and the fascia lata superior capsule reconstruction (444.9 vs 369.0 N, p = .413).
“Fascia lata superior capsule reconstruction has initial stiffness and ultimate load similar to the native superior capsule,” they wrote. “The biomechanical properties of fascia lata allograft makes it an appealing option as a graft choice for superior capsule reconstruction.”
Study authors include Nicholas DeBellis, M.D., James E. Tibone, M.D., and John Manning, M.D., of the Keck School of Medicine of University of Southern California in Los Angeles, California. Victor Hung, B.S., Michelle H. McGarry, M.S., Gregory J. Adamson, M.D., and Thay Q. Lee, Ph.D., of the Congress Medical Foundation in Pasadena, California, 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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