Arthroscopic Superior Capsular Reconstruction with Minimally Invasive Harvested Fascia Lata Autograft: Prospective Study of Donor Site Morbidity

Background: Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs) in active patients are a challenge. Arthroscopic superior capsular reconstruction (ASCR) is a new treatment option originally described using a fascia lata autograft harvested through an open approach. However, concerns about donor site morbidity have discouraged surgeons from using this type of graft. Hypothesis: ASCR using a minimally invasive harvested fascia lata autograft produces good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years. Study Design: Case series; Level of evidence, 4. Methods: From 2015 to 2016, a total of 22 consecutive patients (mean age, 64.8 ± 8.6 years) with chronic IRCTs (Hamada grade 1-2; Goutallier cumulative grade ≥3; Patte stage 1: 2 patients; Patte stage 2: 6 patients; Patte stage 3: 14 patients) underwent ASCR using a minimally invasive harvested fascia lata autograft. All patients completed preoperative and 6-month evaluations consisting of the Simple Shoulder Test (SST), subjective shoulder value (SSV), Constant score (CS), range of motion (ROM), acromiohumeral interval (AHI), and magnetic resonance imaging. Twenty-one patients completed the 2-year shoulder and donor site morbidity assessments. Results: The mean active ROMs improved significantly ( P < .001): elevation, from 74.8° ± 55.5° to 104.5° ± 41.9° (6 months) and 143.8° ± 31.7° (2 years); abduction, from 53.2° ± 43.3° to 86.6° ± 32.9° (6 months) and 120.7° ± 37.7° (2 years); external rotation, from 13.2° ± 18.4° to 27.0° ± 16.1° (6 months) and 35.6° ± 17.3° (2 years); and internal rotation, from 1.2 ± 1.5 points to 2.6 ± 1.5 points (6 months) and 3.8 ± 1.2 points (2 years). The mean functional shoulder scores improved significantly ( P < .001): SST, from 2.1 ± 2.9 to 6.8 ± 3.5 (6 months) and 8.6 ± 3.5 (2 years); SSV, from 33.0% ± 17.4% to 55.7% ± 25.6% (6 months) and 70.0% ± 23.0% (2 years); CS, from 17.5 ± 13.4 to 42.5 ± 14.9 (6 months) and 64.9 ± 18.0 (2 years). The mean shoulder abduction strength improved significantly ( P < .001) from 0.0 to 1.1 ± 1.4 kg (6 months) and 2.8 ± 2.6 kg (2 years). The mean AHI improved from 6.4 ± 3.3 mm to 8.0 ± 2.5 mm (6 months) and decreased to 7.1 ± 2.5 mm (2 years). This 0.7 ± 1.5–mm overall decrease was statistically significant ( P = .042). At 6 months, 20 of 22 patients (90.9%) had no graft tears. At 2 years, 12 of 21 patients (57.1%) were bothered by their harvested thigh, 16 (76.2%) noticed donor site changes, 16 (76.2%) considered that the shoulder surgery’s end result compensated for the thigh’s changes, and 18 (85.7%) would undergo the same surgery again. Conclusion: ASCR using a minimally invasive harvested fascia lata autograft produced good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years.

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Minimally invasive fascia lata harvesting in ASCR does not produce significant donor site morbidity

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-018-5085-1 ◽

2018 ◽

Vol 27 (1) ◽

pp. 245-250 ◽

Cited By ~ 6

Author(s):

Ana Catarina Leiria Pires Gago Ângelo ◽

Clara Isabel de Campos Azevedo

Keyword(s):

Minimally Invasive ◽

Donor Site ◽

Donor Site Morbidity ◽

Fascia Lata

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Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04197-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Marie Protais ◽

Maxime Laurent-Perrot ◽

Mickaël Artuso ◽

M. Christian Moody ◽

Alain Sautet ◽

...

Keyword(s):

Rotator Cuff ◽

Donor Site ◽

Anatomical Study ◽

Donor Site Morbidity ◽

Rotator Cuff Tears ◽

Subacromial Space ◽

Greater Tuberosity ◽

Working Zone ◽

Superior Capsular Reconstruction

Abstract Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

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Direct fascia lata reconstruction to reduce donor site morbidity in endoscopic endonasal extended surgery: a pilot study

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2016.03.003 ◽

2016 ◽

Vol 144 ◽

pp. 59-63 ◽

Cited By ~ 6

Author(s):

Matteo Vitali ◽

Frank Rikki Canevari ◽

Andrea Cattalani ◽

Vincenzo Grasso ◽

Teresa Somma ◽

...

Keyword(s):

Pilot Study ◽

Donor Site ◽

Donor Site Morbidity ◽

Fascia Lata ◽

Endoscopic Endonasal ◽

Extended Surgery

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Editorial Commentary: Human Dermal Allograft Is Preferable to Fascia Lata Autograft Based on Similar Outcomes Without Donor-Site Morbidity

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.05.037 ◽

2021 ◽

Vol 37 (9) ◽

pp. 2797-2799

Author(s):

Adnan Saithna

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Fascia Lata ◽

Editorial Commentary

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REVISITING SUPRACLAVICULAR ARTERY FLAP FOR HEAD AND NECK ONCOLOGIC RECONSTRUCTION.

10.36106/gjra/2513386 ◽

2021 ◽

pp. 220-222

Author(s):

Pranay Bhandari ◽

Ameya Bihani ◽

Pratiksha Pawar

Keyword(s):

Prospective Study ◽

Head And Neck ◽

Buccal Mucosa ◽

Gold Standard ◽

Donor Site ◽

Wound Dehiscence ◽

Donor Site Morbidity ◽

Partial Necrosis ◽

Pros And Cons ◽

A Prospective Study

Background: Head and neck oncologic resections defects are often difcult to reconstruct and are time consuming. An ideal ap should have qualities of both regional and free ap. Our aim in this study is to compare pros and cons of supraclavicular artery ap in comparison to other available ap. This report is a prospective study of cases that underwent supraclavicular artery ap of which, 5 are males and 3 are females. All cases were of carcinoma of Buccal mucosa. 5 cases were completely successful with no complication. One patient had partial necrosis, o Result: ne another patient had distal marginal necrosis with wound dehiscence and one patient had pus discharge with wound dehiscence and orocutaneous stula. No signicant donor site morbidity is seen. This ap has potential to Conclusion: become gold standard in reconstruction of head and neck defects.

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Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques

European Spine Journal ◽

10.1007/s00586-008-0648-3 ◽

2008 ◽

Vol 17 (6) ◽

pp. 845-852 ◽

Cited By ~ 72

Author(s):

Raymond Pollock ◽

Ilhan Alcelik ◽

Chandra Bhatia ◽

Graham Chuter ◽

Kiran Lingutla ◽

...

Keyword(s):

Minimally Invasive ◽

Iliac Crest ◽

Donor Site ◽

Donor Site Morbidity ◽

Cervical Fusion ◽

Bone Harvesting

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807 A Review of The Applications of Autologous Fascia Lata Grafts in Reconstructive Surgery

British Journal of Surgery ◽

10.1093/bjs/znab134.327 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Baldwin ◽

A Lahiri

Keyword(s):

Reconstructive Surgery ◽

Donor Site ◽

Abdominal Wall Reconstruction ◽

Neck Surgery ◽

Donor Site Morbidity ◽

Fascia Lata ◽

Limited Data ◽

Careful Planning ◽

Autologous Grafts ◽

Review Current

Abstract Background We sought to review current applications of fascia lata autografts and update the original collection of uses proposed almost a century ago, thereby revealing the full extent of uses available to the contemporary reconstructive surgeon. Method A comprehensive literature search of peer-reviewed articles listed within PubMed and Medline was performed. Results The properties of autologous fascia lata grafts are presented, a technique for its harvest and the numerous uses of this material in reconstructive surgery. Specifically, its applications in head and neck surgery, surgery of the limbs, abdominal wall reconstruction and penile reconstruction are reviewed. There is limited data on donor site morbidity, but complications appear to be uncommon. However, it was established that the reported risk of muscle herniation varies greatly in the available literature from 0-36% and appears to be related to the width of tissue harvested. Conclusions Autologous fascia lata grafts are a viable and versatile material in the armamentarium of a reconstructive surgeon, that, with careful planning, can be used with minimal donor site morbidity. This is especially true in lower resource settings where a surgeon may not have access to allogenic material and autologous grafts can provide an easily accessible, cheaper, and practical alternative.

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