Summary

Superior capsular reconstruction leads to an improvement of pain and shoulder function in a cohort with irreparable posterosuperior rotator cuff tears.

Abstract

Purpose

The purpose of this study was to evaluate the clinical and radiological outcome following superior capsular reconstruction (SCR) as a salvage procedure for patients with irreparable posterosuperior rotator cuff tears. It was hypothesized that SCR would lead to a significant reduction in pain and improvement of shoulder function, but that a low rate of graft integration would be observed.

Material And Methods

Patients with irreparable posterosuperior rotator cuff tears, who underwent SCR with an allo- (acellular dermal patch) or xenograft (porcine xenograft) between the 05/2018 and 03/2020, were eligible for participation. Pre- and minimum 24 months postoperatively, patient-reported outcome measures (PROMs; American Shoulder and Elbow Society Score (ASES), Subjective Shoulder Value (SSV), Visual Analog Scale [VAS] for pain) and shoulder range of motion were evaluated. Additionally, isometric abduction, flexion and external rotation strength was tested postoperatively using an isokinetic dynamometer and compared to the contralateral side. Lastly, magnetic resonance imaging was performed to evaluate graft integration. The pre- to postoperative change in PROMs and side-to-side difference in ROM as well as isometric strength were tested for statistical significance.

Results

In total, 21 patients (mean age 52.6 ? SD 9.4 years; 59.1% male) were included in the study. In 12 cases (54.5%) an allograft and in 9 cases (45.5%) a xenograft was used. At follow-up (33.6 ? 7.1 months), a significant improvement of the ASES Score (38.0 [interquartile range 21.5-59.0] vs. 70.0 [62.5-95.0]; p<0.001) and the SSV (70 [50-80] vs. 95 [77.5-100]; p=0.004) as well as a significant reduction in pain (VAS for pain 6 [4.0-8.5] vs. 1 [0.0-2.0] ; p<0.001) were reported. Patients’ abduction (80? [45.0-100.0] vs. 145.0? [100.0-165.0]; p=0.004) and flexion (90? [60.0-155.0] vs. 150? [95.0-170.0]; p=0.017) ROM significantly improved, whereas external rotation ROM did not change significantly (p=0,775). Abduction (p<0.001) and flexion (p=0.001) strength was significantly lower when compared to the contralateral side, but no significant difference was noted regarding external rotation strength (p>0.05). Magnetic resonance imaging revealed an SCR-graft integration in one case (5.9%). In total, 4 patients underwent revision surgery (2x latissimus dorsi transfer, 2x reverse total shoulder arthroplasty), which was performed in the xenograft group (44% revision rate for xenografts).

Conclusion

In a cohort with irreparable posterosuperior rotator cuff tears, SCR achieved a significant improvement in shoulder function and reduction in pain. However, an overall low rate of graft integration and high rate of revision when using xenografts should be noted.