These authors sought to evaluate the relationship of clinical outcomes to graft integrity in patients following superior capsular reconstruction (SCR) in 34 patients with minimum 2-year follow-up. Patients underwent an arthroscopic SCR using an acellular dermal allograft (ArthroFlex; Arthrex). In addition to superior capsular reconstruction, 14% of patients underwent subscapularis repair. The biceps tendon was managed by tenodesis in 31% of shoulders and tenotomy in 29% of shoulders, and it was preserved in 31% of shoulders. In the remaining 9% of shoulders, tenodesis had been performed during a prior operation.
Four patients (12%) underwent subsequent surgery (3 reverse total shoulders and 1 latissimus transfer) and were excluded from further analysis.
The mean percent Simple Shoulder Test (SST) improved 22 to 79, the ASES score from 28 to 80, the SANE from 51 to 74 and the VAS from 6.6 to 1.5.
21 shoulders had follow up MRIs which revealed graft failure in 62% (13 of 21). 6 grafts failed at the humeral side, 4 failed at the glenoid side, and 3 were midsubstance graft failures.
The graft failure rate in this study is consistent with that found in other reports: 50% (link) and 55% (link)
Radiographic evidence of graft failure did not have a statistically significant effect on SST, ASES, SANE, or VAS scores.
The authors concluded that graft healing after SCR might not be an independent predictor of success and that clinical improvement in patients undergoing SCR may be due to other aspects of the procedure, including partial rotator cuff repair, debridement, and biceps management. They state, "Given the expense of additional anchors and allograft material, further work will need to be done to better understand the mechanism in which clinical improvements are seen in patients undergoing this complex procedure."
Comment: Another recent article (see this link) reports failure of this graft in spite of active recellularization, revascularization, and remodeling
Good shoulder function in cases of graft failure has been reported previously (see this link and this link)
As pointed out in a recent post (see link), the indications for superior capsular reconstruction in the management of massive cuff tears have yet to be defined. Further clinical research is needed to demonstrate an incremental value for SCR beyond that achieved with lesser procedures, such as partial rotator cuff repair, debridement, and biceps management (see link).
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