Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Anterior capsular reconstruction with acellular dermal allograft for subscapularis deficiency: a report of two cases

  • Raffy Mirzayan (Department of Orthopedic Surgery, Kaiser Permanente Southern California) ;
  • Shane Korber (Department of Orthopedic Surgery, University of Southern California)
  • Received : 2023.03.30
  • Accepted : 2023.07.17
  • Published : 2024.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Anterior glenohumeral instability with an irreparable subscapularis tear is a challenging problem for the orthopedic shoulder surgeon. Current techniques, including tendon transfers, yield inconsistent results with high rates of recurrent instability. Acellular dermal allografting has been used in young patients with massive superior rotator cuff tears with early success, but acellular dermal allografting is comparatively unstudied in anterior deficiency. We present two cases of anterior capsular reconstruction with an acellular dermal allograft in patients ages 66 and 58 years with irreparable subscapularis tendon tears. Follow-up for both patients exceeded 4 years, with forward flexion >140°, external rotation exceeding 60°, a Single Assessment Numeric Evaluation score >90 points, a visual analog scale score of 0 points, and an American Shoulder and Elbow Score of 98 points. In conclusion, acellular dermal allografting can be used to reconstruct the anterior capsule in patients with massive irreparable subscapularis tears, similar to its use in superior capsular reconstruction in patients with massive posterosuperior rotator cuff tears.

Keywords

References

  1. Shin JJ, Saccomanno MF, Cole BJ, Romeo AA, Nicholson GP, Verma NN. Pectoralis major transfer for treatment of irreparable subscapularis tear: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016;24:1951-60. https://doi.org/10.1007/s00167-014-3229-5
  2. Komperda KW, Adamson GJ, Itami Y, et al. Anterior capsule reconstruction versus pectoralis major transfer for irreparable subscapularis tears involving the anterior capsule: a comparative biomechanical cadaveric study. Arthroscopy 2019;35:3002-8. https://doi.org/10.1016/j.arthro.2019.05.046
  3. Elhassan B, Ozbaydar M, Massimini D, Diller D, Higgins L, Warner JJ. Transfer of pectoralis major for the treatment of irreparable tears of subscapularis: does it work. J Bone Joint Surg Br 2008;90:1059-65.
  4. Omid R, Stone MA, Lin CC, et al. Biomechanical analysis of anterior capsule reconstruction and latissimus dorsi transfer for irreparable subscapularis tears. J Shoulder Elbow Surg 2020;29:374-80. https://doi.org/10.1016/j.jse.2019.07.033
  5. Dewing CB, Horan MP, Millett PJ. Two-year outcomes of open shoulder anterior capsular reconstruction for instability from severe capsular deficiency. Arthroscopy 2012;28:43-51. https://doi.org/10.1016/j.arthro.2011.07.002
  6. Tokish JM, Beicker C. Superior capsule reconstruction technique using an acellular dermal allograft. Arthrosc Tech 2015;4:e833-9. https://doi.org/10.1016/j.eats.2015.08.005
  7. Denard PJ, Brady PC, Adams CR, Tokish JM, Burkhart SS. Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft. Arthroscopy 2018;34:93-9. https://doi.org/10.1016/j.arthro.2017.08.265
  8. Mirzayan R, Stone MA, Batech M, Acevedo DC, Singh A. Failed dermal allograft procedures for irreparable rotator cuff tears can still improve pain and function: the "biologic tuberoplasty effect". Orthop J Sports Med 2019;7:2325967119863432.
  9. Kwapisz A, Tokish JM. Anterior capsule reconstruction technique with an acellular dermal allograft. Arthrosc Tech 2017;6:e1945-52. https://doi.org/10.1016/j.eats.2017.07.012
  10. Myers D, Triplet JJ, Johnson DB, Strakowski JA, Wiseman SP, Long NK. Anterior capsular reconstruction using a dermal allograft for an irreparable subscapularis tear after shoulder arthroplasty: a case report. JBJS Case Connect 2020;10:e0468.