Achilles Tendon Allograft for Superior Capsule Reconstruction in Irreparable Massive Rotator Cuff Tears

BACKGROUD: Treatment remains a challenge in massive and irreparable rotator cuff tears (RCTs), and superior capsular reconstruction (SCR) has become an increasingly popular choice. The objective of this study was to evaluate clinical and radiological outcomes after SCR using an Achilles tendon allograft in irreparable massive RCTs. METHODS: From December 2015 to March 2018, 11 patients (mean age, 66.3 ± 5.8 years) with irreparable massive RCTs who underwent SCR using an Achilles tendon allograft were enrolled in this study. The range of motion (ROM), visual analog scale (VAS), clinical scores, muscle strength, and acromiohumeral distance (AHD) were measured preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 months postoperatively to assess the global fatty degeneration index and graft failure. Ultrasonography was also conducted preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively to assess graft continuity. RESULTS: The mean follow-up period was 27.6 months (range, 24–32 months). The shoulder ROM at final follow-up increased significantly in forward flexion (p = 0.023), external rotation (p = 0.018), internal rotation (p = 0.016), and abduction (p = 0.011). All patients showed improvement in VAS score (p = 0.005) and clinical scores (p < 0.001) compared with the preoperative state. Pseudoparalysis improved in all patients. The AHD was 3.88 mm (± 1.21 mm) preoperatively, 7.75 mm (± 1.52 mm, p = 0.014) at 6 months postoperatively, and 6.37 mm (± 1.72 mm, p = 0.031) at final follow-up. Graft removal and synovectomy were performed in 1 patient who developed postoperative infections. Radiological failure on follow-up MRI occurred in 2 patients at 6 and 12 months postoperatively, respectively. CONCLUSIONS: SCR using an Achilles tendon allograft in irreparable massive RCTs achieved functional and clinical improvement. The use of Achilles tendon allograft also has the advantages of short operation time without donor site morbidity, sufficient thickness, and robustness; therefore, this allograft can be a useful graft for SCR.