Open Anterior Capsular Reconstruction With a Dermal Allograft Is a Viable Nonarthroplasty Salvage Procedure for Irreparable Subscapularis Tears at a Minimum 2-Year Follow-up

Authors:

Lee S, Rakowski DR, Horan MP, Hanson JA, Ernat JJ, Millett PJ

Abstract:

Purpose

To elucidate the clinical outcomes of patients who underwent anterior capsular reconstruction (ACR) with dermal allograft for irreparable subscapularis tears in native shoulders at a minimum of 2-year follow-up.

Methods

This study included patients who underwent ACR by a single surgeon between March 2015 and September 2018. Clinical and intraoperative findings were recorded. Patient-reported outcomes were evaluated pre- and postoperatively, including American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, General Health Short-Form 12 Physical Component Summary and patient satisfaction (on a 1-10 scale, with 10 = best). Failure was defined as revision subscapularis surgery or conversion to reverse total shoulder arthroplasty.

Results

Seven patients who underwent ACR at a mean age of 53 ± 7.3 years at the time of surgery were included. Median time from injury to surgery was 13.8 months (range 13.8-32.0 months). Two patients had concomitant superior capsular reconstruction. One patient progressed to a reverse total shoulder arthroplasty at 6.8 months. Minimum 2-year follow-up was obtained in the remaining 6 of 6 (100%) patients, with a mean follow-up of 3.4 years (range 2.0-6.2). There was significant improvement in the Quick Disabilities of the Arm, Shoulder and Hand score (preoperative: 32.7, postoperative: 9.5, P = .04), whereas the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, and SF-12 PCS scores demonstrated nonsignificant improvement. Median patient satisfaction was 9.5 (range 7-10).

Conclusions

This small cohort of patients had a significant improvement in Quick Disabilities of the Arm, Shoulder and Hand score, high patient satisfaction, and relatively low conversion rate to reverse total shoulder arthroplasty. These clinical outcomes demonstrate that ACR with a dermal allograft may be a viable salvage operation for irreparable subscapularis tears in the short-term.

Level of Evidence:

Level IV, therapeutic case series.

You can download the study:

Open Anterior Capsular Reconstruction With a Dermal Allograft Is a Viable Nonarthroplasty Salvage Procedure for Irreparable Subscapularis Tears at a Minimum 2-Year Follow-up

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

Submit your review
Name:
Email:
Website:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel