Shoulder Superior Capsular Reconstruction Using Xenograft Shows No Deterioration in Functional Improvement at 5-Year Follow-Up.

Abstract

To examine functional outcomes and radiographic shoulder findings at mid-term after superior capsular reconstruction for irreparable rotator cuff ruptures using a porcine dermal graft. Clinical results for patients not older than 70 years of age with a chronic irreparable superior or posterosuperior tendon defect, which included either a total defect of the supraspinatus tendon or a larger defect, including both the supraspinatus and infraspinatus tendons, treated with a xenograft superior capsular reconstruction technique during a 5-year period between October 2015 and January 2020. Patients were evaluated using the Constant score and Western Ontario Rotator Cuff (WORC) index over a minimum 5-year follow-up. All operated shoulders had magnetic resonance imaging of the injured shoulder after 1 year and after 5 years or later with a qualitative radiographic evaluation of graft integrity. Preoperative x-rays and x-rays at mid-term were classified according to the Hamada classification. Twenty-three patients were operated on. Twenty-one patients completed a mid-term follow-up (range, 60-101 months; mean, 71 months). Mean age was 57 years at the time of surgery. No correlation was found between functional outcome scores, graft durability, and Hamada grade. There was no correlation between functional outcome and any progression of radiographic rotator cuff arthropathy. Patients with a single-tendon defect or patients with no prior rotator cuff operation had better outcomes than patients with a 2-tendon defect and patients with a prior operation. At final follow-up for 21 patients, the mean Constant score improved from an average of 26 points to 68 points (P < .001). The mean WORC index increased from a percentage average of 29% to 76% (P < .001). Twenty-one of 21 patients exceeded recognized minimal clinically important difference (MCID) levels for their Constant scores, and 20 of 21 patients exceeded MCID levels for their WORC indices. At mid-term follow-up, no further complications in terms of graft tears, infections, or revisions were registered. The clinical failure rate was 1 patient out of 21. At the time of completed mid-term follow-up, a substantial number of patients (95%) achieved the MCID for the Constant scores and WORC indices, with no deterioration in functional improvement. No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified. Level IV, retrospective case series.