Arthroscopic dynamic reconstruction of supraspinatus tendon with autologous fascia lata combined with artificial ligament for irreparable massive rotator cuff tears

Irreparable massive rotator cuff tears (IMRCTs) represent a formidable challenge in shoulder surgery, frequently leading to persistent pain, dysfunction, and progressive disability. Effective and durable treatment strategies remain an area of ongoing investigation. This study aimed to evaluate the short-term outcomes of a novel arthroscopic technique using a composite graft of autologous fascia lata and artificial ligament for dynamic reconstruction of the supraspinatus tendon in patients with IMRCTs. We retrospectively analyzed 15 patients with IMRCTs who underwent this combined arthroscopic procedure at our institution between January 2022 and January 2023. Patients were followed for a mean of 24.3 &#xb1; 0.62 months (range: 24-26 months). Preoperative and postoperative assessments included shoulder range of motion (ROM), visual analog scale for pain, and functional scores such as the University of California, Los Angeles Shoulder Rating Scale, American Shoulder and Elbow Surgeons score, and Constant-Murley score. Rotator cuff integrity was assessed by magnetic resonance imaging at follow-up. Significant improvements were observed in all outcome measures at final follow-up (all P < .001): visual analog scale (4.6 &#xb1; 0.5 to 1.1 &#xb1; 0.3), American Shoulder and Elbow Surgeons (42.5 &#xb1; 3.9 to 87.5 &#xb1; 3.8), University of California, Los Angeles (11.5 &#xb1; 1.8 to 31.0 &#xb1; 2.3), and Constant-Murley (29.4 &#xb1; 5.4 to 84.1 &#xb1; 6.4) scores. ROM significantly improved: forward flexion (69&#xb0; &#xb1; 9&#xb0; to 148&#xb0; &#xb1; 7&#xb0;), abduction (61&#xb0; &#xb1; 13&#xb0; to 135&#xb0; &#xb1; 11&#xb0;), external rotation (22&#xb0; &#xb1; 7&#xb0; to 54&#xb0; &#xb1; 4&#xb0;) and internal rotation (19.7 &#xb1; 1.1&#xb0; to 25.0 &#xb1; 0.8&#xb0;). Postoperative magnetic resonance imaging demonstrated graft healing (Sugaya type I or II) in all cases. No complications occurred. Arthroscopic dynamic reconstruction of the supraspinatus tendon using an autologous fascia lata and artificial ligament (Ligament Advanced Reinforcement System, LARS) composite graft yielded significant short-term improvements in pain, function, and ROM for patients with IMRCTs. This technique combines biological healing potential with mechanical reinforcement. However, these findings are preliminary due to the study's limitations, including its small sample size, retrospective design, and short follow-up. Larger, long-term studies are warranted to validate these results and assess the durability of the reconstruction.