Combined Superior Capsular Reconstruction Using Fascia Lata Autograft and Lower Trapezius Transfer Using Achilles Tendon Allograft Are Associated With Improved Surgical Outcomes in Patients With Chronic Posterosuperior Irreparable Massive Rotator Cuff Tears.

Abstract

<h4>Purpose</h4>To evaluate the minimum 12-month clinical and radiologic outcomes of combined superior capsular reconstruction (SCR) and lower trapezius transfer (LTT) for posterosuperior irreparable massive rotator cuff tears (IMRCTs).<h4>Methods</h4>Patients with posterosuperior IMRCTs and severe fatty infiltration (Goutallier grade ≥3) of the infraspinatus who underwent combined SCR and LTT were retrospectively reviewed. A double-folded fascia lata autograft with 1 layer of polypropylene mesh inside was used for SCR, and an Achilles tendon allograft was used to connect the tendon of the lower trapezius to the greater tuberosity. A thorough preoperative assessment with clinical history, physical examination, and imaging studies was critical for identifying tear patterns that were reparable or irreparable and to guide further treatment. American Shoulder and Elbow Surgeons (ASES), visual analog scale (VAS), Constant, Single Assessment Numeric Evaluation (SANE) scores, and range of motion were collected at a minimum 12-month follow-up postoperatively. Radiologic evaluation included graft integrity and the acromiohumeral distance at the final follow-up. Postoperative magnetic resonance imaging was used to assess graft integrity. The minimal clinically important difference was calculated as one-half of the standard deviation of the score change between the preoperative baseline and the latest follow-up.<h4>Results</h4>Fifteen patients were included in this study, with a mean follow-up period of 20.6 months (range, 12.2-31.2 months). Significant improvements in clinical and radiologic outcomes were found after surgery. The VAS score decreased from 4.1 to 0.7 (P = .001). The ASES, Constant, and SANE scores improved from 54.5 to 83.7 (P = .001), from 61.1 to 76.7 (P = .001), and from 48.7 to 74.0 (P = .001), respectively. External rotation improved from 26.0° to 45.7° (P = .009). Postoperative magnetic resonance imaging scans were obtained at a mean final follow-up of 14.2 months (range, 11.9-23.2). The acromiohumeral distance improved significantly from 4.9 mm to 8.1 mm after surgery (P = .003). In 2 patients (13.3%), both fascia lata and Achilles tendon graft tears developed during follow-up. The minimal clinically important difference was obtained in 80.0%, 66.7%, 53.3%, and 46.7% of patients for the ASES score, VAS score, Constant score, and SANE score, respectively.<h4>Conclusions</h4>SCR-LTT contributes to significant pain relief and functional improvements with a graft healing rate of 86.7% at a minimum 12-month follow-up in patients with posterosuperior IMRCTs and high-grade fatty infiltration of the infraspinatus.<h4>Level of evidence</h4>Level IV, retrospective case series.