Arthroscopic Superior Capsular Reconstruction With a Minimally Invasive Harvested Fascia Lata Autograft Produces Good Clinical Results

Background: Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs) in active patients are a challenge. Arthroscopic superior capsular reconstruction (ASCR) is a new treatment option originally described using a fascia lata autograft harvested through an open approach. However, concerns about donor site morbidity have discouraged surgeons from using this type of graft. Hypothesis: ASCR using a minimally invasive harvested fascia lata autograft produces good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years. Study Design: Case series; Level of evidence, 4. Methods: From 2015 to 2016, a total of 22 consecutive patients (mean age, 64.8 +/- 8.6 years) with chronic IRCTs (Hamada grade 1-2; Goutallier cumulative grade >= 3; Patte stage 1: 2 patients; Patte stage 2: 6 patients; Patte stage 3: 14 patients) underwent ASCR using a minimally invasive harvested fascia lata autograft. All patients completed preoperative and 6-month evaluations consisting of the Simple Shoulder Test (SST), subjective shoulder value (SSV), Constant score (CS), range of motion (ROM), acromiohumeral interval (AHI), and magnetic resonance imaging. Twenty-one patients completed the 2-year shoulder and donor site morbidity assessments. Results: The mean active ROMs improved significantly (P < .001): elevation, from 74.8 degrees +/- 55.5 degrees to 104.5 degrees +/- 41.9 degrees (6 months) and 143.8 degrees +/- 31.7 degrees (2 years); abduction, from 53.2 degrees +/- 43.3 degrees to 86.6 degrees +/- 32.9 degrees (6 months) and 120.7 degrees +/- 37.7 degrees (2 years); external rotation, from 13.2 degrees +/- 18.4 degrees to 27.0 degrees +/- 16.1 degrees (6 months) and 35.6 degrees +/- 17.3 degrees (2 years); and internal rotation, from 1.2 +/- 1.5 points to 2.6 +/- 1.5 points (6 months) and 3.8 +/- 1.2 points (2 years). The mean functional shoulder scores improved significantly (P < .001): SST, from 2.1 +/- 2.9 to 6.8 +/- 3.5 (6 months) and 8.6 +/- 3.5 (2 years); SSV, from 33.0% +/- 17.4% to 55.7% +/- 25.6% (6 months) and 70.0% +/- 23.0% (2 years); CS, from 17.5 +/- 13.4 to 42.5 +/- 14.9 (6 months) and 64.9 +/- 18.0 (2 years). The mean shoulder abduction strength improved significantly (P < .001) from 0.0 to 1.1 +/- 1.4 kg (6 months) and 2.8 +/- 2.6 kg (2 years). The mean AHI improved from 6.4 +/- 3.3 mm to 8.0 +/- 2.5 mm (6 months) and decreased to 7.1 +/- 2.5 mm (2 years). This 0.7 +/- 1.5-mm overall decrease was statistically significant (P = .042). At 6 months, 20 of 22 patients (90.9%) had no graft tears. At 2 years, 12 of 21 patients (57.1%) were bothered by their harvested thigh, 16 (76.2%) noticed donor site changes, 16 (76.2%) considered that the shoulder surgery's end result compensated for the thigh's changes, and 18 (85.7%) would undergo the same surgery again. Conclusion: ASCR using a minimally invasive harvested fascia lata autograft produced good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years.