Supraspinatus Tendon Reconstruction Using Fascia Lata Autograft for Irreparable Posterosuperior Massive Rotator Cuff Tears

Fascia Lata Autografts Achieve Interface Healing With the Supraspinatus Muscle Histologically and Mechanically in a Rat Supraspinatus Tendon Reconstruction Model for Massive Irreparable Rotator Cuff Tears

PURPOSE

To evaluate the histologic healing process and mechanical characteristics of the interface between a fascia lata autograft and supraspinatus muscle by establishing a supraspinatus tendon reconstruction model for chronic massive irreparable rotator cuff tears (MIRCTs).

METHODS

A total of 40 rats were studied. Eight rats were killed to establish an intact control group, and the other rats were first established as a chronic MIRCT model and then developed as the supraspinatus tendon reconstruction model. Histology, fatty infiltration, mechanics, and open field test for the interface between the fascia lata autograft and muscle were assessed at 2, 4, 8, and 16 weeks postoperatively.

RESULTS

Histologically, the interface between the fascia lata autograft and muscle gradually regenerated structural characteristics similar to the normal muscle-tendon interface by 16 weeks postoperatively. The amount of collagen I and III increased significantly during the healing time and stabilized at 8 weeks postoperatively. Fatty infiltration was obvious in the supraspinatus muscle 4 weeks after establishing the MIRCT model. However, the degree of fatty infiltration in the supraspinatus muscle gradually decreased after supraspinatus tendon reconstruction and stabilized at 8 weeks postoperatively. The ultimate failure force and ultimate stress gradually increased from 2 to 16 weeks and reached the level of the intact control tendon at 16 weeks postoperatively (P = .086). The movability of the forepaw returned to normal in the open field test (P = .907).

CONCLUSIONS

In this rat supraspinatus tendon reconstruction model, fascia lata autografts showed good interface healing with the supraspinatus muscle, and fatty infiltration in the supraspinatus muscle was histologically decreased. The interface between the fascia lata autograft and muscle showed mechanical strength similar to the anatomic muscle-tendon interface.

CLINICAL RELEVANCE

A supraspinatus tendon reconstruction technique using fascia lata autografts might be a good histologic and biomechanical option for treating MIRCTs.

Arthroscopic Biologic Acromiotuberoplasty for Irreparable Rotator Cuff Tears

Recent attention has turned toward the prevention of acromiohumeral abutment in the treatment of irreparable rotator cuff tears (IRCTs). This can be achieved through tendon transfer with a bridging allograft, superior capsular reconstruction, dermal allograft application to the greater tuberosity (biologic tuberoplasty), bursal acromial reconstruction, or subacromial balloon spacer placement. Recent literature has demonstrated increased graft thickness is associated with improved clinical outcomes after superior capsular reconstruction, suggesting a potential role of a direct bone-to-bone contact between the greater tuberosity and acromion in symptom generation in patients with IRCTs. In keeping with this ethos and building on the principle of both biologic tuberoplasty and bursal acromial reconstruction, the authors propose biologic acromiotuberoplasty as a treatment for IRCTs wherein a 3-mm dermal allograft is fixated to both the greater tuberosity of the humerus and the undersurface of the acromion for a total of 6 mm of allograft interposition.

Supraspinatus Tendon Reconstruction Versus the Bridging Technique in a Rat Model: Histological, Biomechanical, and Functional Outcomes

BACKGROUND

Massive irreparable rotator cuff tears (MIRCTs) are among the most challenging shoulder conditions to treat surgically. Supraspinatus tendon reconstruction (STR) is a recently introduced technique for MIRCTs based on fascia lata-muscle interface healing, which completely differs from the classic bridging technique with fascia lata-tendon interface healing. However, histological and biomechanical comparisons of the fascia-muscle and fascia-tendon interfaces have not been performed.

PURPOSE

To investigate the histological and biomechanical healing of the fascia-bone interface and fascia-muscle interface after chronic MIRCTs in a rat model using different surgical methods.

STUDY DESIGN

Controlled laboratory study.

METHODS

The authors established a chronic MIRCT model in the right shoulder of rats and then repaired it using the STR or bridging repair technique. Evaluations were performed at 2, 4, 8, and 12 weeks, including histological, imaging, biomechanical, and functional analyses.

RESULTS

Both techniques resulted in good fascia-bone interface healing based on the histological results. The STR group had significantly more cartilage formation at 8 and 12 weeks and higher Modified Tendon Maturity Score after 12 weeks at the fascia-bone interface compared with the bridging repair group and formed the typical 4-layered structure. Collagen fibers in the fascia-muscle and fascia-tendon interfaces exhibited normal muscle-tendon interface characteristics at 12 weeks. However, the STR group had more improvement in fatty infiltration compared with the bridging repair group. The ultimate failure load and stiffness did not differ between the STR and bridging repair groups 4 weeks postoperatively in both the fascia-bone interface and supraspinatus muscle-fascia-bone integrity. Movement distance and grasp time were significantly longer in the STR group than in the bridging repair group at 12 weeks and attached the level in the normal control groups.

CONCLUSION

These results suggest that the fascia-muscle interface from the STR technique is histologically and functionally better than the fascia-tendon interface. Moreover, this study provides a theoretical basis for the clinical use of the STR technique.

CLINICAL RELEVANCE

The fascia-muscle interface and fascia-tendon interface were the key points of the STR and bridging techniques, respectively. The fascia-muscle interface is histologically and functionally superior to the bridging technique, and the STR technique might be a better choice for the treatment of MIRCTs.

Arthroscopic Superior Capsular Reconstruction Using Hybrid Autologous Fascia Lata and the Long Head of Biceps Tendon Graft: the Central Beam Concept

Superior capsular reconstruction is a joint salvage treatment option for retracted irreparable rotator cuff tears in relatively young patients. Various graft options have been described in the literature, including autologous fascia lata graft, synthetic graft, and dermal patches. Superior capsular reconstruction using long head of biceps tendon autograft alone has also been described by few authors. In this technical note, we describe a modified technique of performing arthroscopic superior capsular reconstruction using both fascia lata graft and the intra articular portion of the long head of biceps tendon. Our technique resembles central beam concept over which the fascia lata graft is anchored, providing good structural support to the graft and enabling graft healing and improved clinical outcomes.

Clinical effectiveness of supraspinatus tendon reconstruction using autogenous fascia latas for irreparable posterosuperior massive rotator cuff tears: study protocol for a randomized, controlled clinical trial

BACKGROUND

Supraspinatus tendon reconstruction (STR) was recently introduced as a new treatment option for irreparable posterosuperior massive rotator cuff tears (IPMRCT). STR was thought to be more advantageous than superior capsule reconstruction (SCR) for restoring supraspinatus (SSP) dynamics. However, there has been no prospective randomized controlled study on the early clinical efficacy of STR.

METHODS

A single-site, prospective, observers and patients double-blinding randomized controlled trial was designed. Fifty-eight patients aged 50-85 years with IPMRCT will be randomized 1:1 to receive either STR or SCR. The clinical outcomes were evaluated using the American Society for Shoulder and Elbow Surgery (ASES) score, range of motion (ROM), visual analogue scale (VAS) for pain, acromiohumeral distance (AHD), Goutlliar grade for fatty infiltration in the SSP, Sugaya grade for the autogenous fascia latas, isokinetic muscle strength testing and surface electromyography (EMG) testing for shoulder abduction muscle strength and complications.

DISCUSSION

The results of this study will contribute to the treatment algorithm of IPMRCT and assist surgeons in making treatment decisions. This is the first randomized controlled trial to compare the effects of STR and SCR for the treatment of IPMRCT.

TRIAL REGISTRATION

We registered the trial in chictr.org.cn on July 17, 2023 (register number: ChiCTR2300073716). Items from the WHO trial registry were found within the protocol.