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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(05): 876-883
DOI: 10.1055/s-0041-1732389
Artigo Original
Ombro e Cotovelo

Treatment of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction with Fascia Lata Allograft

Article in several languages: português | English
Rodrigo Alves Beraldo 
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
Mauro Emilio Conforto Gracitelli 
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
Eduardo Angeli Malavolta 
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
Jorge Henrique Assunção 
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
Fernando Brandão de Andrade e Silva 
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
,
Arnaldo Amado Ferreira Neto 
1   Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Abstract

Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft.

Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI).

Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p = 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p = 0.001; p = 0.005; and p = 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p = 0.003; 30 to 60°, p = 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing.

Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Keywords

rotator cuff injuries/surgery - shoulder joint - joint capsule - fascia lata/transplantation - treatment outcome

Author's Contributions

Each author contributed individually and significantly to the development of the present article:


RAB: wrote the article; performed the surgeries; data collection; approved the final version.


MECG: wrote the article; performed the surgeries; follow-up of the patients; approved the final version.


EAM: statistical analysis; bibliographic review; approved the final version.


JHA: interpreted the results of the study; bibliographic review; clinical examination; approved the final version.


FBAS: data collection; survey of medical records; follow-up of the patients; approved the final version.


AAFN: participated in the review process; clinical examination; approved the final version.


* Work developed in the Shoulder and Elbow Group of the Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.




Publication History

Received: 21 October 2020

Accepted: 11 February 2021

Article published online:
11 November 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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