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Although many superior capsule reconstruction (SCR) techniques are currently practiced in clinical settings, there is a lack of guideline for choosing the appropriate graft material. Therefore, at most times the surgeon's personal preference becomes the deciding factor. This study compares two fairly recent SCR techniques, biceps tendon (BT) autograft and humeral dermal (HD) allograft, by evaluating the clinical and radiologic outcomes to aid the surgeon's decision in choosing the appropriate graft.Thirty-one patients underwent SCR using BT and 22 using HD. SCR BT was selected for patients with BT partial tear of less than 20%, no severe inflammation sign, and favorable anchor condition. SCR HD was done in patients when BT had a tear of more than 20%, a SLAP lesion, severe inflammation, or subluxation. Range of motion, strength and shoulder function scoring, plain radiography, and MRI were evaluated before and after surgery in regular intervals.In SCR BT group, forward flexion (FF) ROM increased from 121.94±43.24 to 148.71±17.46 after 2nd year of surgery, whereas in the SCR HD group the FF ROM improved from 129.09±27.76 to 148.64±17.81. In SCR BT group, internal rotation (IR) ROM increased from 5.29±2.56 to 5.55±1.82 after 2nd year of surgery, whereas in the SCR HD group the IR ROM improved from 4.77±2.52 to 6.36±1.09. Although ROM, strength, visual analog scale, American Shoulder and Elbow Surgeons score and Constant-Murley score all improved 2 years after surgery, no statistically significant difference was found. Six months after surgery, the graft thickness in the BT group was 3.58±0.384mm and 2.49±0.326mm for the HD group (P0.001). After 2 years, graft thickness in the BT and HD groups were 3.54±0.399mm and 2.49±0.306mm respectively (P0.001). SCR HD group showed a negative correlation of -0.475 between graft thickness and IR ROM (P = 0.026). In the SCR BT group, a negative correlation of -0.466 was found between graft thickness and IR ROM (P = 0.008). A positive correlation of 0.363 was found between ROM IR and AHD (Acromiohumeral distance) when results were compared before and 2 years after surgery (P = 0.045).SCR that used auto-BT and allo-HD tissue both showed favorable results, and no significant difference was noted between the two techniques. Given that the two techniques show equally favorable results, the surgeon's personal preference on choosing the SCR technique appears to be acceptable. Understanding the costs and patient's characteristics may aid the surgeon in deciding on the graft material. |
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