Histology of Explanted ArthroFlex SCR

Biological Incorporation of ArthroFlex® in Superior Capsular Reconstruction for Irreparable Rotator Cuff Repair
Evan Lederman MD*, Davorka Softic MS, Xiao fei Qin MD PhD, Brian Samsell BS, Amy Dorfman BS

After four failed shoulder surgeries, including one failed revision RCR in 2009, this patient underwent SCR with ArthroFlex SCR augmentation in 2015. Theysustained a shoulder injury during a fall 10 weeks post-operative, and MRIs showed repair failure — suspected to be a result of the fall — at six months and 12 months post-operative. The graft was explanted during a debridement surgery 13 months post-op, sent to LifeNet Health courtesy of Dr. Lederman and prepared for histological analysis.

The explant sample was dissected to four quarters via the mid-line, formalin-fixed, paraffin-embedded, crosssectioned, and stained with hematoxylin and eosin (H&E) for analysis. Histological analysis showed that ArthroFlex maintained the acellular dermal matrix structure for about 80% of explanted tissue. Infiltrated fibroblastlike cells and neovascularization were most located at the edges. Thecenter of the ArthroFlex tissue remained acellular and avascular, while no signs of necrosis or calcification were observed. Tendon-like tissue structure was found near the glenoid attachment point. Fibrocartilage-like tissue was observed at the edges of the explanted graft on the articular side towards the patient’s own cartilage.

The fibroblast infiltration, neovascularization and tissue remodeling seen here demonstrated that ArthroFlex can adapt to the local environment and have good incorporation following SCR.

1Agrawal H, Tholpady SS, Capito AE, Drake DB, Katz AJ. Macrophage phenotypes correspond with remodeling outcomes of various acellular dermal matrices. Open Journal of RegenerativeMedicine. 2012;01(03):51-59.
2Tokish JM, Beicker C. Superior Capsule Reconstruction Technique Using an Acellular Dermal Allograft. Arthrosc Tech. Dec 2015;4(6):e833-839.
3Capito AE, Tholpady SS, Agrawal H, Drake DB, Katz AJ. Evaluation of host tissue integration, revascularization, and cellular infiltration within various dermal substrates. Ann Plast Surg. May 2012;68(5):495-500.
* Dr. Evan Lederman is a paid consultant of Arthrex, Inc.