Arthroscopic Superior Capsule Reconstruction With Combined Fascia Lata Autograft Augmented With Either LARS Ligament or Polypropylene Mesh Synthetic Scaffold Patch Graft: A Comparison of Techniques With a Minimum 2-Year Follow-up for the Treatment of Irreparable Rotator Cuff Tears

Abstract

Background:

Arthroscopic superior capsule reconstruction (ASCR) with combined fascia lata autograft and synthetic scaffold patch graft has been reported to improve graft healing and treat irreparable rotator cuff tears (RCTs). Information about the surgical outcomes of using different synthetic scaffold materials is limited.

Purpose:

To compare the clinical outcomes of the ASCR technique using LARS ligament with polyethylene terephthalate (PET) material versus polypropylene (PP) mesh scaffold augmentation to treat irreparable RCTs.

Study Design:

Case series; Level of evidence, 4.

Methods:

The data of 92 patients with irreparable RCTs who underwent ASCR between 2016 and 2022 were retrospectively evaluated. Among them, 82 of 92 patients who met the inclusion and exclusion criteria were available for follow-up. Fascia lata autografts augmented with LARS ligament (LARS with PET; Corin Group) were used in 43 patients (LARS group), and fascia lata autografts with PP mesh augmentation were used in 39 patients (mesh group). Clinical outcomes were evaluated preoperatively and at a final follow-up by a visual analog scale for pain score and range of motion along with the American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, and Constant-Murley score (CMS). Radiological outcomes were assessed according to the rotator cuff arthropathy and acromiohumeral distance stages. Graft integrity and muscle fatty infiltration were evaluated by magnetic resonance imaging.

Results:

Both groups showed significant improvement in clinical and radiological outcomes at the final follow-up. The LARS group showed significantly better outcomes in mean ASES score (92.6 ± 8.0 vs 77.8 ± 21.3; P < .001), UCLA score (31.5 ± 3.9 vs 24.4 ± 7.5; P < .001), and CMS (86.6 ± 7.2 vs 67.9 ± 18.9; P < .001) compared with the mesh group. The mean active elevation was significantly higher in the LARS group (161.4 ± 19.7) than in the mesh group (124.2 ± 31.3) (P < .001). The graft healing rate was also significantly higher in the LARS group (91%) than in the mesh group (72%) (P = .027), and acromiohumeral distance was significantly greater in the LARS group (7.0 ± 1.5 mm) than in the mesh group (6.3 ± 1.5 mm) at the final follow-up (P = .036). Subgroup analysis revealed that patients with intact grafts demonstrated a more substantial improvement in functional outcomes and active elevation.

Conclusion:

Compared with combining ASCR with a synthetic PP mesh scaffold graft, augmenting autogenous fascia lata ASCR with a synthetic LARS ligament scaffold graft achieved better functional outcomes and graft healing rate.