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Published on: December 22, 2015
Sequential Changes in Angiogenesis After Arthroscopic Superior Capsule Reconstruction Using Fascia Lata Autograft
Akihiro Uchida1,2, Akihiko Hasegawa2, Yusuke Noguchi2
1Department of Orthopedic Surgery, Yaenosato Hospital, Higashiosaka, Japan.
Purpose:
To evaluate sequential changes in angiogenesis after superior capsule reconstruction using fascia lata autograft with power Doppler ultrasound and to investigate the relation between angiogenesis-related findings and clinical outcomes.
Methods:
Thirty patients with irreparable rotator cuff tears who underwent superior capsule reconstruction using a fascia lata autograft were prospectively enrolled. Angiogenesis and blood flow volume in the superficial layered tissue in contact with the bursal side of the graft (perigraft) and within the graft on the greater tuberosity and humeral head were evaluated using Fealy's scoring system with power Doppler ultrasound at 6 weeks and 3, 6, and 12 months postoperatively. Visual analog scale (VAS) score for shoulder pain, Neer and Hawkins tests, and American Shoulder and Elbow Surgeons (ASES) score were evaluated preoperatively and postoperatively. Minimal clinically important difference achievement rates for VAS and ASES scores were also evaluated.
Results:
All grafts (100%) showed angiogenesis within the 6-month postoperative period. In the perigraft, the rate of cases with angiogenesis and blood flow scores was highest at 6 weeks and then significantly decreased at 12 months (90%-47%, P = .0003; 1.2-0.6 points, P = .04). Angiogenesis within the graft on the greater tuberosity significantly increased at 3 months (43%-77%, P = .004), with blood flow scores peaking at 6 months (0.3-1.3 points, P = .02). No significant correlations were observed between blood flow and VAS or ASES scores (P = .16-.99) or between angiogenesis and impingement tests (P = .09->.99). Minimal clinically important difference achievement rates were 93.3% for VAS and 100% for ASES scores.
Conclusions:
Overall, the minimal clinically important difference achievement rates were 93.3% for the VAS and 100% for the ASES scores after superior capsule reconstruction. Postoperatively, all grafts displayed progressive angiogenesis and pulsatile blood flow, with volume peaking at 6 months. Notably, these sequential changes in vascularization may represent a physiological graft healing and remodeling process rather than pain-related inflammation.
Level Of Evidence:
Level II, prospective cohort study.
