Superior Capsular Reconstruction with Mesh Augmentation: a Perspective from Bench to Bedside

OBJECTIVES: Superior capsular reconstruction (SCR) is an alternative to treat massive chronic rotator cuff tear with the premise to provide static restraint avoiding upward migration of the humeral head. However, graft tears and their impact on clinical function outcomes following SCR is still in contentious. We aimed to compare clinical and radiologic outcomes following arthroscopic SCR using fascia lata graft with or without mesh augmentation in massive chronic rotator cuff tear. METHODS: There were 63 patients underwent SCR with fascia lata from 2014 to 2017. From 2013 to 2016, only fascia lata tendon was used, categorized as fascia lata only group (F). From 2016 to 2018, a mesh is added in the reconstructed capsule, categorized as mesh group (M). Mesh was fashioned inside the folded fascia lata graft for the purpose of structural augmentation. The final study population included 34 and 24 shoulders in group F and M, respectively. All patients were followed for a minimum of 3 months, with mean total follow-ups of 31.3 ± 8.2 and 11.45 ± 11.6 months in Group F and M, respectively. Average ages were 64.9 ± 8.7 and 65.1 ± 6.1 years in Group F and M, respectively. Assessment of both clinical and radiological outcome was conducted at the final follow up. The clinical outcome included ASES (American Shoulder Elbow Society) score and VAS (Visual Analogue Scale) score. The radiological outcome included the re-tear rate and AHD (Acromio-humeral distance). RESULTS: Overall, all scores in ASES (40.8 to 78.4), VAS (6.2 to 3.0) and AHD were improved. Both groups showed improvement of clinical and radiological outcome. ASES score was improved from 54.43 ± 17.27 to 73.7 ± 13.8 for group F, and 48.13 ± 13.2 to 77.42 ± 12.04 for group M. VAS score was improved from 6 ± 1.13 to 2.5 ± 0.87 for group F, and 5.72 ± 1.07 to 2.4 ± 0.84. AHD was significantly superior in group M (9.08 ± 2.43 mm) compared to group F (6.36 ± 1.80 mm) at the final follow up. The re-tear rate was found higher at group F for 41.1% compared to group M for 16.6% (Table 2). There was no significant difference for both groups regarding demographic data (age, sex, preoperative VAS score, ASES score, ROM). CONCLUSION: The early graft tear rate for SCR was 41.4%. Mesh augmentation can reduce for more than half of the graft tear rate from 41.4% to 16.6% by providing structural support. In conclusion, SCR with mesh augmentation for massive rotator cuff tear showed better clinical outcome with a lower re-tear rate compared to conventional SCR with fascia lata only.