Superior capsular reconstruction by Facia Lata versus dermal allograft for massive cuff tears patients: a systematic review

Background
Massive rotator cuff tears (MRCT) are defined by Cofield and Gerber as injuries with a diameter of five centimeters or greater, involving the complete rupture of two or more tendons. These tears present challenges for shoulder surgeons due to muscle adipose infiltration, tendon retraction, and potential involvement of the teres minor and subscapularis muscles.
Objective
To evaluate the clinical outcomes comparing superior capsular reconstruction (SCR) utilizing Human Dermal Allograft (HDA) versus Tensor Fascia Lata Autograft (TFL) assessing the efficacy and safety of each management modality.
Methods
There was no explicit financial support from private, public, we diligently adhered to the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions while conducting this systematic review. Throughout the research’s design process, we additionally ensured compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We utilized PubMed, Scopus, Web of Science, and Cochrane Library to conduct a literature search. scanned for studies published between 2007 and 2021. A literature search was performed to detect researches that compared the safety and effectiveness of SCR utilizing TFL Autograft versus HDA.
Results
Overall, both graft types demonstrated effectiveness in improving clinical outcomes, with patients experiencing enhanced shoulder function and decreased pain after the arthroscopic SCR procedure. The results vary among studies, which different patient populations, surgical techniques, and graft thicknesses might influence. The table provides valuable insights into the outcomes of SCR surgeries using TFL and HDA grafts, helping guide treatment decisions for patients with massive irreparable rotator cuff tears (MIRCTs). Outcomes are assessed using various measures, including external rotation, acromiohumeral distance, graft tear rates, graft survival rate, single-strand vascularization, and subscapularis tendon tears. Our results showed that both TFL and HDA groups have demonstrated effectiveness in improving clinical outcomes for patients with MIRCTs. However, the graft tear rates seem to be advanced in the HDA collection compared with the TFL collection in some studies.
Conclusion
This detailed analysis of studies comparing HDA and TFL for SCR in individuals with MIRCTs reveals several important findings. Both graft types demonstrate efficacy in improving clinical outcomes, including decreased pain, enhanced shoulder function, and increased range of motion.