Anterior capsular reconstruction in irreparable subscapularis tear: human dermal allograft

Yong Girl Rhee; Tae Hyun Kyeong; Sung Min Rhee; Radhakrishna Kantanavar

doi:10.1016/j.jse.2023.04.029

Anterior capsular reconstruction in irreparable subscapularis tear: human dermal allograft

J Shoulder Elbow Surg. 2023 Nov;32(11):2256-2263. doi: 10.1016/j.jse.2023.04.029. Epub 2023 May 31.

Authors

Yong Girl Rhee¹, Tae Hyun Kyeong¹, Sung Min Rhee², Radhakrishna Kantanavar³

Affiliations

¹ Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Kyunggi Gyeonggi-do, Republic of Korea.
² Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, KyungHee University Hospital, Seoul, Republic of Korea.
³ Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Kyunggi Gyeonggi-do, Republic of Korea. Electronic address: krishnakantanavar@gmail.com.

PMID: 37263481
DOI: 10.1016/j.jse.2023.04.029

Abstract

Background: The irreparable subscapularis (SSc) tears pose an extremely difficult situation to manage, especially in the younger population. The anterior capsular reconstruction (ACR) with human dermal allograft (HDA) is an alternative to tendon transfer with sound biomechanical advantages and clinical outcomes. The purpose of this study was to evaluate the early clinical and radiologic outcomes of open ACR with HDA in patients with irreparable SSc tears.

Methods: Eighteen patients who had an open ACR with HDA for irreparable SSc tears between August 2020 and January 2022 were enrolled. There were 11 male and 7 female patients with a mean age of 63.7 years and a mean follow-up of 17 months (range, 12-28 months). The dominant side was affected in 10 patients. One of the 18 patients had reconstruction with single-layer HDA, 14 had double-layer HDA, and 3 had SSc augmentation over double-layer HDA. Clinical and radiologic outcomes were assessed and compared pre- and postoperatively.

Results: There was significant improvement in visual analog scale score from 6.6 ± 1.6 to 1.6 ± 1.5 (P < .001) and in the total University of California-Los Angeles shoulder score from 12.4 ± 4.3 to 29.0 ± 4.5 (P < .001). Forward flexion, abduction, and internal rotation (IR) increased by 28.6°, 32.5°, and 11.8°, respectively (P < .001). External rotation decreased by 6.4° (P = .020). There was notable improvement in IR strength (percentage of that of the opposite, normal side) from 66.0% ± 19.4% to 84.4% ± 22.3% (P = .008). The mean postoperative coracohumeral distance improved from 3.0 to 6.0 mm (P < .001), the anterior translation of the humeral head reduced from 1.5 to 0.5 mm (P = .210), and the acromiohumeral interval from 8.1 to 8.8 mm (P = .070). The patients' satisfaction at final follow-up was rated 4.1 of 5.0 (P < .001). Sixteen of 18 patients (88.9%) had the HDA healed at the glenoid and humeral side, and 2 (11.1%) had retear at the final follow-up. Among the 17 who had double-layer HDA, none showed any healing between the layers.

Conclusion: This study showed that early significant and comprehensive improvement inclusive of pain relief, improvement in range of motion, IR strength, and reduction of anterosuperior translation was achievable by open ACR with HDA for irreparable SSc tear.

Keywords: Complete subscapularis tear; anterior capsular deficiency; anterior capsular reconstruction; anterosuperior translation; human dermal allograft; irreparable subscapularis tear.