Shoulder Superior Capsular Reconstruction Using Xenograft Shows No Deterioration in Functional Improvement at 5-Year Follow-Up
Bibliographic record
Abstract
PURPOSE: To examine functional outcomes and radiographic shoulder findings at mid-term after superior capsular reconstruction for irreparable rotator cuff ruptures using a porcine dermal graft. METHODS: Clinical results for patients not older than 70 years of age with a chronic irreparable superior or posterosuperior tendon defect, which included either a total defect of the supraspinatus tendon or a larger defect, including both the supraspinatus and infraspinatus tendons, treated with a xenograft superior capsular reconstruction technique during a 5-year period between October 2015 and January 2020. Patients were evaluated using the Constant score and Western Ontario Rotator Cuff (WORC) index over a minimum 5-year follow-up. All operated shoulders had magnetic resonance imaging of the injured shoulder after 1 year and after 5 years or later with a qualitative radiographic evaluation of graft integrity. Preoperative x-rays and x-rays at mid-term were classified according to the Hamada classification. RESULTS: Twenty-three patients were operated on. Twenty-one patients completed a mid-term follow-up (range, 60-101 months; mean, 71 months). Mean age was 57 years at the time of surgery. No correlation was found between functional outcome scores, graft durability, and Hamada grade. There was no correlation between functional outcome and any progression of radiographic rotator cuff arthropathy. Patients with a single-tendon defect or patients with no prior rotator cuff operation had better outcomes than patients with a 2-tendon defect and patients with a prior operation. At final follow-up for 21 patients, the mean Constant score improved from an average of 26 points to 68 points (P < .001). The mean WORC index increased from a percentage average of 29% to 76% (P < .001). Twenty-one of 21 patients exceeded recognized minimal clinically important difference (MCID) levels for their Constant scores, and 20 of 21 patients exceeded MCID levels for their WORC indices. At mid-term follow-up, no further complications in terms of graft tears, infections, or revisions were registered. The clinical failure rate was 1 patient out of 21. CONCLUSIONS: At the time of completed mid-term follow-up, a substantial number of patients (95%) achieved the MCID for the Constant scores and WORC indices, with no deterioration in functional improvement. No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified. LEVEL OF EVIDENCE: Level IV, retrospective case series.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".