These authors evaluated clinical outcomes and graft integrity in patients following superior capsular reconstruction (SCR) in thirty-four consecutive patients.
All patients had a preoperative diagnosis of massive irreparable rotator cuff tear with retraction to the level of the glenoid. Additionally, a preoperative diagnosis of pseudoparesis was present in 23% of shoulders (n=8 of 35 shoulders).
Patients underwent an arthroscopic débridement, decompression, and partial rotator cuff repair with arthroscopic SCR utilizing an acellular dermal allograft.
The mean preoperative scores were SST 21.6 ± 17.6, ASES 28.3 ± 10.1, SANE 50.6 ± 22.1, and VAS 6.6 ± 1.7.
The mean postoperative outcomes were SST 79.1 ± 19.6, ASES 79.9 ± 17.4, SANE 74.3 ± 18.7, and VAS 1.5 ± 2.2.
There was statistically significant improvement in SST, ASES, and VAS following SCR.
Torn grafts were defined as having discontinuity from the glenoid to the greater tuberosity on 2 consecutive T2-weighted MRI images in the coronal plane. MRI imaging revealed graft failure in 62% (n=13 of 21) of shoulders. Of the shoulders with graft failure, six grafts failed at the humeral side, four failed at the glenoid side, and three were mid-substance graft failures.
Radiographic evidence of graft healing did not have a statistically significant effect on SST, ASES, SANE, or VAS scores.
The authors concluded that given the high rate of graft failure without a significant difference in clinical outcomes, graft healing after SCR might not be an independent predictor of success. The improved clinical improvement in patients undergoing SCR may be due to other known beneficial aspects of the procedure, including partial rotator cuff repair, débridement, and biceps management.
Comment: This small study may be insufficiently powered to detect the differences in outcome between patients with intact and those with failed SCRs.
Nevertheless, it is worth considering the authors' question: "is the benefit of SCR more related to cuff integrity or to the non-SCR elements of the SCR surgery?".
An alternative approach to the surgical management of irreparable rotator cuff tears in patient with retained active elevation is shown in this link.
