Alan M. Hirahara, MD, FRCSC
Orthopaedic SurgeonSpecialist in Sports Medicine

Ultrasound Assessment of the Superior Capsular Reconstruction With Dermal Allograft: An Evaluation of Graft Thickness and Vascularity

Hirahara AM, Andersen WJ, Panero AJ
DOI: 10.1016/j.arthro.2019.06.042
PMID: 31785745

December 2nd 2019

Purpose: To assess postoperative changes in the thickness of the dermal allograft of the superior capsular reconstruction (SCR) and to evaluate the graft for the presence of intrasubstance pulsatile vessels.

Methods: A retrospective chart review was conducted to identify SCR patients who had ultrasound evaluations between May 2014 and February 2019. Data were collected and stratified based on time from surgery into 2 groups: 0 to 12 months and past the 12-month follow-up. The primary outcome measure was graft thickness at the articular marginegreater tuberosity interface (tuberosity measurement). Secondary measures included midsubstance graft thicknesses 0.5, 1.0, and 1.5 cm medial to the tuberosity measurement; status of lateral graft fixation; presence of pulsatile vessels; and American Shoulder and Elbow Society and visual analog scale scores.

Results: Eighteen patients were included for analysis. The tuberosity measurement at final follow-up (mean 25 months, range 12-40 months) was (mean +- standard error [95% confidence interval (CI)]) 4.4 +- 0.2 mm (95% CI 4.0-4.8). This differed significantly from the midsubstance measurements: 0.5 cm: 3.6 +- 0.2 mm (95% CI 3.3-4.0, P ¼ .008); 1.0 cm: 3.1 +- 0.2 mm (95% CI 2.7-3.4, P < .001); and 1.5 cm: 2.9 +- 0.2 mm (95% CI 2.6-3.2, P < .001). Ten constructs 56%) showed signs of pulsatile vessels in the first 12 months and all constructs were intact. ASES scores improved from 49.3 +- 4.0 (95% CI 41.6-57.1) preoperatively to 85.1 +- 2.9 (95% CI 79.4-90.8) (P < .001), and VAS scores decreased from 5.3 +- 0.6 (95% CI 4.2-6.5) preoperatively to 0.9 +- 0.3 (95% CI 0.3-1.5) at final follow-up (P < .001).

Conclusions: The SCR dermal allograft significantly thickens at its lateral aspect, presents with evidence of vasculature in most patients in the first year of implantation, and is not resorbed by the body.

Level of Evidence: Level IV, therapeutic case series.