Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jan 9:9:939096.
doi: 10.3389/fsurg.2022.939096. eCollection 2022.

Biomechanical outcomes of superior capsular reconstruction for irreparable rotator cuff tears by different graft materials-a systematic review and meta-analysis

Xiaoxiong Zhao  1 , Jialin Jia  1 , Liang Wen  1 , Bo Zhang  1
Affiliations
Review

Biomechanical outcomes of superior capsular reconstruction for irreparable rotator cuff tears by different graft materials-a systematic review and meta-analysis

Xiaoxiong Zhao et al. Front Surg. .

Erratum in

Abstract

Background: Irreparable rotator cuff tears (IRCT) are defined as defects that cannot be repaired due to tendon retraction, fat infiltration, or muscle atrophy. One surgical remedy for IRCT is superior capsular reconstruction (SCR), which fixes graft materials between the larger tuberosity and the superior glenoid.

Patients and methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria were followed for conducting the systematic review and meta-analysis. From their inception until February 25, 2022, Pubmed, Embase, and Cochrane Library's electronic databases were searched. Studies using cadavers on SCR for IRCT were also included. The humeral head's superior translation and subacromial peak contact pressure were the primary outcomes. The humeral head's anteroposterior translation, the kind of graft material used, its size, and the deltoid load were the secondary outcomes.

Results: After eliminating duplicates from the search results, 1,443 unique articles remained, and 20 papers were finally included in the quantitative research. In 14 investigations, the enhanced superior translation of the humeral head was documented in IRCTs. In 13 studies, a considerable improvement following SCR was found, especially when using fascia lata (FL), which could achieve more translation restraints than human dermal allograft (HDA) and long head of bicep tendon (LHBT). Six investigations reported a subacromial peak contact pressure increase in IRCTs, which could be rectified by SCR, and these studies found a substantial increase in this pressure. The results of the reduction in subacromial peak contact pressure remained consistent regardless of the graft material utilized for SCR. While there was a statistically significant difference in the change of graft material length between FL and HDA, the change in graft material thickness between FL and HDA was not significant. The humeral head's anterior-posterior translation was rising in IRCTs and could be returned to its original state with SCR. In five investigations, IRCTs caused a significant increase in deltoid force. Furthermore, only one study showed that SCR significantly decreased deltoid force.

Conclusion: With IRCT, SCR might significantly decrease the glenohumeral joint's superior and anterior-posterior stability. Despite the risks for donor-site morbidity and the longer recovery time, FL is still the best current option for SCR.

Keywords: biomechanics; graft; material; rotator cuff; superior capsular reconstruction.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of literature processing.
Figure 2
Figure 2
(A) forest plot comparing the mean difference (MD) of superior translation of humeral head between intact cuff and IRCT. (B) Forest plot comparing the mean difference (MD) of superior translation of humeral head between IRCT and SCR. (C) Forest plot comparing the mean difference (MD) of superior translation of humeral head between Intact cuff and SCR.
Figure 3
Figure 3
(A) Forest plot comparing the mean difference (MD) of subacromial peak contact pressure between Intact cuff and IRCT. (B) Forest plot comparing the mean difference (MD) of subacromial peak contact pressure between IRCT and SCR. (C) Forest plot comparing the mean difference (MD) of subacromial peak contact pressure between Intact cuff and SCR.
Figure 4
Figure 4
(A) Forest plot comparing the mean difference (MD) of thickness of graft materials in pre- and post-test. (B) Forest plot comparing the mean difference (MD) of length of graft materials in pre- and post-test.
Figure 5
Figure 5
(A) Forest plot comparing the mean difference (MD) of antero-posterior translation of humeral head between Intact cuff and IRCT. (B) Forest plot comparing the mean difference (MD) of antero-posterior translation of humeral head between IRCT and SCR. (C) Forest plot comparing the mean difference (MD) of antero-posterior translation of humeral head between Intact cuff and SCR.
Figure 6
Figure 6
(A) Forest plot comparing the mean difference (MD) of deltoid force between Intact cuff and IRCT. (B) Forest plot comparing the mean difference (MD) of deltoid force between IRCT and SCR. (C) Forest plot comparing the mean difference (MD) of deltoid force between Intact cuff and SCR.
Figure 7
Figure 7
The funnel plots for the size of grafts (A), anteroposterior translation of humeral head (B), and deltoid force (C).
None
None
None
None
None
None
None
None
None
See this image and copyright information in PMC

References

    1. Pashuck TD, Hirahara AM, Cook JL, Cook CR, Andersen WJ, Smith MJ. Superior capsular reconstruction using dermal allograft is a safe and effective treatment for massive irreparable rotator cuff tears: 2-year clinical outcomes. Arthrosc. (2021) 37(2):489–96 e1. 10.1016/j.arthro.2020.10.014 - DOI - PubMed
    1. Ishigaki N, Hata Y, Matsuba T, Hino M, Murakami N, Kobayashi H. Long-term results of partial repair for irreparable rotator cuff tear. JSES Int. (2021) 5(4):642–8. 10.1016/j.jseint.2021.02.010 - DOI - PMC - PubMed
    1. Oh JH, Park MS, Rhee SM. Treatment strategy for irreparable rotator cuff tears. Clin Orthop Surg. (2018) 10(2):119–34. 10.4055/cios.2018.10.2.119 - DOI - PMC - PubMed
    1. Elhassan BT, Wagner ER, Werthel JD. Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear. J Shoulder Elbow Surg. (2016) 25(8):1346–53. 10.1016/j.jse.2015.12.006 - DOI - PubMed
    1. Kovacevic D, Suriani RJ Jr., Grawe BM, Yian EH, Gilotra MN, Hasan SA, et al. Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response. J Shoulder Elbow Surg. (2020) 29(12):2459–75. 10.1016/j.jse.2020.07.030 - DOI - PMC - PubMed

LinkOut - more resources