A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear

J Shoulder Elbow Surg. 2017 Dec;26(12):2158-2166. doi: 10.1016/j.jse.2017.07.019.

Abstract

Background: Biomechanical and clinical success of the superior capsule reconstruction (SCR) using fascia lata (FL) grafts has been reported. In the United States, human dermal (HD) allograft has been used successfully for SCRs; however, the biomechanical characteristics have not been reported.

Methods: Eight cadaveric shoulders were tested in 5 conditions: (1) intact; (2) irreparable supraspinatus tear; (3) SCR using FL allograft with anterior and posterior suturing; (4) SCR using HD allograft with anterior and posterior suturing; and (5) SCR using HD allograft with posterior suturing. Rotational range of motion, superior translation, glenohumeral joint force, and subacromial contact were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Graft dimensions before and after testing were also recorded. Biomechanical parameters were compared using a repeated-measures analysis of variance with Tukey post hoc test, and graft dimensions were compared using a Student t-test (P < .05).

Results: Irreparable supraspinatus tear significantly increased superior translation, superior glenohumeral joint force, and subacromial contact pressure, which were completely restored with the SCR FL allografts. Both SCR HD allograft repairs partially restored superior translation and completely restored subacromial contact and superior glenohumeral joint force. The HD allografts significantly elongated by 15% during testing, whereas the FL allograft lengths were unchanged.

Conclusions: Single-layered HD SCR allografts partially restored superior glenohumeral stability, whereas FL allograft SCR completely restored the superior glenohumeral stability. This may be due to the greater flexibility of the HD allograft, and the SCR procedure used was developed on the basis of FL grafts.

Keywords: Superior capsule reconstruction; allograft; biomechanics; cadaver study; fascia lata; human dermal; subacromial contact pressure; superior translation.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Allografts
  • Biomechanical Phenomena
  • Cadaver
  • Fascia Lata / transplantation*
  • Female
  • Humans
  • Joint Capsule / surgery*
  • Male
  • Middle Aged
  • Movement
  • Range of Motion, Articular
  • Reconstructive Surgical Procedures / methods*
  • Rotator Cuff Injuries / surgery*
  • Shoulder Joint / physiopathology*
  • Shoulder Joint / surgery
  • Skin Transplantation*
  • Suture Techniques*