These authors point out that the ideal solution for the irreparable rotator cuff tear remains in question. While patients having a superior capsular reconstruction (SCR) have achieved some promising results; however, even though 15,000 SCRs have been done worldwide there remains a paucity of outcome data.
One of the most notable aspects of these data is that in most cases the patients had preoperative active elevation to or above the horizontal (the one exception is groups 2 and 3 of Mihata).
For patients with irreparable cuff tears and retained active elevation, a simpler and less costly procedure, the smooth and move procedure, has been shown to be effective in restoring comfort and function to the shoulder (see this video and these reports: report1, report2). In contrast to the SCR, patients having the smooth and move procedure are able to begin active assisted and active motion immediately after surgery.
Here is an example of an active man who presented with right shoulder pain. His images at that time are shown below
Because he had minimal glenohumeral arthritis and retained active elevation of 130 degrees, he elected to proceed with a smooth and move procedure. At surgery, he had retracted irreparable subscapularis, supraspinatus, and subscapularis tendons and mild cuff tear arthropathy.
Less than 24 hours after surgery, he had the shoulder function shown below.
He returned to commercial truck driving two weeks after his surgery.
This case illustrates the utility of this conservative surgical procedure in shoulders with retained active elevation.
Future studies of the SCR must stratify the results by preoperative active elevation and avoid co-mingling patients with retained active elevation with those without retained active elevation. Otherwise we will not know whether SCR offers an advantage in treating shoulders with retained active elevation. Recalling that the cost of a procedure includes not only the surgical cost (i.e. dermal allograft), but also the down time off work after surgery (see this link).
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