Superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement or balloon spacers for large and massive irreparable rotator cuff tears: a systematic review and meta-analysis

Abstract

Background Multiple non-arthroplasty surgical techniques are described for the management of large and massive irreparable rotator cuff tears. There is currently no consensus on the best management strategy. Our aim was to compare clinical outcomes following arthroscopic debridement, arthroscopic partial cuff repair, superior capsule reconstruction, balloon spacers or graft interposition for the management of large and massive irreparable rotator cuff tears. Methods A comprehensive search was performed of the following databases: Medline, Embase, CINAHL and Cochrane Database of Systematic Reviews. Data were extracted from relevant studies published since January 2000 according to the pre-specified inclusion criteria. The primary outcome was the post-operative improvement in shoulder scores. Meta-analysis of the primary outcome was performed. Secondary outcomes included retear rates and complications. Results Eighty-two studies were included reporting the outcomes of 2790 shoulders. Fifty-one studies were included in the meta-analysis of the primary outcome. The definition of an irreparable tear varied. All procedures resulted in improved shoulder scores at early follow-up. Shoulder scores declined after 2 years following balloon spacers, arthroscopic debridement and partial cuff repair. High retear rates were seen with partial cuff repairs (45%), graft interposition (21%) and superior capsule reconstruction (21%). Conclusions Large initial improvements in shoulder scores were demonstrated for all techniques despite high retear rates for reconstructive procedures. Shoulder scores may decline at mid- to long-term follow-up.

Up to date diagnosis and treatment of massive irreparable cuff tears: Results of the survey of the U45 ESSKA Committee

“…It has been widely confirmed in the literature that attempting to repair as much as possible of the cuff, converting it into a functional rotator cuff tear by recreating a balanced forced couple, can be helpful in reducing pain, as well as improving functional outcomes [7,9]. However, despite the improved functional outcomes, partial repair of the cuff often leads to not negligible retear rates [7] and glenohumeral alterations at the midterm follow-up [20]. More severe scenarios, such as external rotation with the arm at the side + external rotation at 90°of abduction lag (infraspinatus and teres minor complete dysfunction) without pseudoparalysis, need additional considerations.…”

Arthroscopic Medialization Partial Repair with Biologic Interposition Tuberoplasty for Large to Massive Irreparable Rotator Cuff Tear

“…However, at the 2-year mark post-surgery, the groups undergoing balloon spacers, arthroscopic debridement, and partial cuff repair exhibited unfavorable outcomes in shoulder scores. Additionally, high rates of retear were reported in partial cuff repairs (45%), and superior capsule reconstruction (21%) [ 28 ]. Therefore, methods aimed at reducing tension, such as footprint medialization repair, have been reported to decrease retear rates [ 9 , 29 ].…”

Treatment of irreparable rotator cuff tear with dual graft reconstruction: a case report and technique description

“…However, there is a wide range of radiographic findings for intact bridging rotator cuff grafts. 8 Aggregate reporting on SCR have detailed satisfactory improvement in clinical outcomes 7 and variable rates of reoperation with the most common being revision to RSA. 22 Notably, recent analysis has suggested that a superior capsule graft may not need to demonstrate radiographic healing to yield the intended effect of mechanical impedance to superior translation of the humerus.…”

“…This may reduce the risk of graft failure that has been reported for single graft reconstruction. 7 , 12 …”