Arthroscopic Superior Capsule Reconstruction (ASCR) vs Latissimus Dorsi Transfer (LDT): A Comparison of Early Clinical Outcomes

Abstract

Objectives:

Arthroscopic superior capsule reconstruction (ASCR) has been introduced as an alternative to latissimus dorsi transfer (LDT) for the treatment of irreparable rotator cuff tears in young patients. The hypothesis of this study is that preliminary clinical outcomes for SCR patients will not significantly differ from those of LDT patients for irreparable and massive rotator cuff tears.

Methods:

Patients who underwent either a LDT or an ASCR and were a minimum of 6 months (mean, 12 months) out from surgery were included. In the SCR technique, a 3-mm acellular human dermal allograft was customized to the exact size of the defect. Surgical, objective, and demographic data were prospectively collected and retrospectively reviewed. Patient-reported outcome (PRO) measures included ASES, SANE, QuickDASH, SF-12 and satisfaction scores. Acromiohumeral distance (AHD) was measured and Hamada classification applied. Patients progressing to reverse shoulder arthroplasty (rTSA) or patients with a graft disruption were considered failures.

Results:

34 patients (13 women, 21 men) with a mean age of 52±7.4 years were included in this study. 16 patients underwent SCR reconstruction while 18 patients underwent LDT. Compared to the SCR group, the LDT group was significantly younger (49 years vs. 56 years; p=.006) and had a higher percentage of Workman’s Compensation cases (61% vs. 6%; p=.001). Failure of the repair occurred in one patient in the ASCR group (6.2%), who suffered a graft tear seen on MRI at 141 days postoperatively, and two patients (11%) in the LDT group, both of whom progressed to rTSA. Two additional patients (11%) in the LDT group had subsequent surgery around one-year postoperatively - an arthroscopic cuff repair and hardware removal. In those who did not fail, pain significantly decreased postoperatively in both groups (p<0.05). Only patients who underwent ASCR had a statistically significant functional improvement (p=0.002 vs. p=0.161). Mean change in abduction and flexion were -7.3° and 0.6°, respectively, in the LDT group, compared to 56.0° and 21.7°, respectively, in the ASCR group. At final follow-up, satisfaction was a median 8/10 points in both groups.

Conclusion:

Patients who underwent ASCR had significantly improved clinical scores and improved range of motion compared to patients who underwent LDT, but longer follow-up is needed.