It has been proposed that superior capsule reconstruction (SCR) improves shoulder stability and function and decreases pain in patients with irreparable rotator cuff tears.
These authors evaluated the association between graft healing and in vivo kinematics, range of motion (ROM), strength, and patient reported outcome (PROs) in ten patients (8M, 2F, age 63 ± 7 years) with irreparable rotator cuff tear having arthroscopic SCR with dermal allograft.
Healing was evaluated at five locations as either healed or not healed: anterior and posterior glenoid, anterior and posterior humerus, and posteriorly along the infraspinatus.
Four of the ten patients had complete healing, five had partial healing of the graft while one had complete failure of healing at the glenoid.
No correlation existed between MRI healing and acromiohumeral distance, scapulo humeral rhythm, strength, range of motion or patient reported outcomes.
The authors concluded that in vivo kinematics changes were small after SCR and not clinically significant, and that improvements in clinical and functional outcomes may occur in absence of full graft healing.
Comment: This small study suggests that the outcome of SCR does not depend on complete graft healing.
It is of interest that these patients with irreparable cuff tears had excellent function preoperatively: 150 degrees of abduction and 151 degrees of flexion. After SCR all patients underwent a standard six-month rehabilitation protocol concentrating on ROM and gentle shoulder strengthening. At one year after surgery abduction averaged 166 degrees and flexion averaged 163 degrees. One wonders if these gains could have been achieved with the 6 month rehab program without the SCR.
Patients having irreparable cuff tears with retained active elevation can be treated with a less invasive approach as shown in this link.
