Superior capsular reconstruction for irreparable rotator cuff tears: A literature review and specialist practice report

Abstract

Background: Recent evidence continues to confirm the effectiveness of arthroscopic superior capsular reconstruction (SCR) in relieving pain and improving function in an irreparable cuff deficient shoulder. This paper presents an up-to-date literature review on SCRand a tertiary referral unit experience in the United Kingdom. Methods: Data was prospectively collected on patients undergoing SCR for irreparable rotator cuff tears using a dermal allograft. Patients with already established arthritis were excluded. The first 49 consecutive cases performed by 3 surgeons over 3 years (including their learning curve) with average follow-up of 19 months (range 3e37 months) were analysed. The outcomes assessed were re-operation rates, patient satisfaction and complications. The study group was analysed to identify the factors predicting outcomes. Results: The average age of the cohort was 56 years. The re-operation rate in this group was 12.2% with each of these 6 patients subsequently undergoing a reverse total shoulder arthroplasty. Forty (82%) patients were satisfied with the outcome of the procedure with 35 (72%) of them showing complete pain relief, 5 (10%) having dull aches and clicks and the remaining 9 (18%) unsatisfied due to pain. There was no difference in satisfaction rates between different age groups (p > 0.05). The pre-operative factors associated with poor outcomes included patients with multiple previous surgeries on the same shoulder (p ¼ 0.02) and teres minor atrophy or tear (p ¼ 0.03). The other factors that showed a trend towards inferior outcomes (but not statistically significant) included patients with degenerative tears, symptoms of longer duration (>24 months) and subscapularis tear/atrophy. No serious adverse effects such as graft rejection, infection or neuro-vascular injury were observed. Conclusion: Early results of superior capsular reconstruction are promising and may offer an answer to a challenging group of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery.

Multiple surgical treatment comparisons for irreparable rotator cuff tears: A network meta-analysis

“…[36] From a biomechanical point of view, when the shoulder joint is elevated, the graft can play a role in strengthening the stable arm bone and soft tissue, allowing the entire front and rear of the shoulder joint to pass through. [37] Early clinical results of the application of autologous fascia lata are expected to reduce pain and function in patients. [38] Another study by Mihata et al [39] in 2018 showed that the reversal rate of pseudoparalysis in patients with IRCTs was 94.9% with SCR, which was comparable to the 90% pseudoparalysis in SCR patients reported by Denard et al [40] pseudoparalysis (no more than 45 in forward flexion) was reversed with consistent results.…”

Superior capsular reconstruction: current evidence and limits

“…Other alternative procedures for irreparable posterosuperior RCTs include debridement, biceps tenotomy or tenodesis, subacromial decompression, tendon transfer, and bridging graft ( 30 ).…”

The changing landscape of rotator cuff surgery

“…c o m / l o c a t e / j c o t significant interest in using bridging graft connecting the superior surface of the glenoid to greater tuberosity footprint to restore the superior capsule of the shoulder. 12 Insertion of a biodegradable balloon in the subacromial space to reduce acromio-humeral contact and aid deltoid function has also been explored. 13 Such "disruptive" technologies seek to lower the surgical risks and morbidities associated with tendon transfers which require a more extensive surgical dissection.…”