Superior Capsule Reconstruction With Thicker Human Dermal Allograft Leads to Lower Lateral‐Sided Graft Tears and Better Functional Outcomes

PURPOSE: To compare clinical and magnetic resonance imaging results of patients who underwent superior capsule reconstruction with a 3 mm (Group 1) versus 6 mm (Group 2) human dermal allograft. METHODS: Between September 2014 and February 2022, patients who underwent superior capsule reconstruction at a single institution, with a minimum of 1-year follow-up, were included. Preoperative age, sex, and Hamada grade were recorded. Pre- and postoperative acromiohumeral distance, American Shoulder and Elbow Surgeons (ASES), Oxford, visual analog scale (VAS) for pain, and postoperative single-assessment numeric evaluation score were recorded. Postoperative magnetic resonance image was routinely obtained regardless of symptoms. RESULTS: There were 39 shoulders in Group 1 and 22 shoulders in Group 2. There was no difference between in preoperative age (P = .6412), acromiohumeral distance (P = .7638), ASES (P = .4612), and Oxford (P = .55517). There was significant improvement in both groups in ASES, Oxford, and VAS (P < .0001), but no difference in acromiohumeral distance for Group 1 (P = .666) or Group 2 (P = .1188). There was a significant difference between Group 1 and 2 in postoperative ASES (76.6 vs 94, P = .0002), Oxford (41.7 vs 47, P = .0005), VAS (2.2 vs 0.3, P = .0062), and single-assessment numeric evaluation (75 vs 92.3, P = .0002). Group 2 had a lower graft tear rate (27.3% vs 64.1%, P = .0057). Group 2 also had a significantly lower lateral-sided graft failure (0% vs 40%, P = .0099). In Group 1, 87% met minimal clinically important difference for ASES, 77% for Oxford, and 90% for VAS. In addition, 67% met substantial clinical benefit for ASES, 64% for Oxford, and 72% for VAS. In Group 2, 100% met minimal clinically important difference for ASES, Oxford, and VAS and 100% met SCB. CONCLUSIONS: Patients who undergo superior capsule reconstruction with a 6 mm human dermal allograft have significantly lower lateral-sided graft tears, leading to better functional outcomes compared with those with 3 mm grafts. LEVEL OF EVIDENCE: Level III, retrospective comparative study.