Summary

Arthroscopic superior capsular reconstruction is a promising option to treat irreparable rotator cuff tears in young patients. Surgical modification using polypropylene mesh augmentation to the graft material may help reduce graft failure.

Abstract

Background

Arthroscopic superior capsular reconstruction (ASCR) is an alternative to open surgery for irreparable chronic rotator cuff tears. This approach can provide static restraint while avoiding upward migration of the humeral head. However, graft tears and their impact on clinical outcomes following ASCR remain a debated topic.

Purpose

This study aimed to evaluate the clinical outcomes of ASCR with mesh augmentation for the treatment of irreparable rotator cuff tears (IRCTs).
Study Design: Retrospective case–control study

Methods

From 2013 to 2018, the data of 72 patients with IRCTs who underwent ASCR were retrospectively evaluated. Among them, 64 patients who met the inclusion and exclusion criteria were enrolled in this study. Fascia lata grafts augmented with a polypropylene mesh were used for 30 patients (group M) and grafts without mesh augmentation were used for 34 patients (group C). Clinical outcomes were evaluated using range of motion, the American Shoulder and Elbow Surgeons (ASES) questionnaire, and Visual Analog Scale for pain. Radiological outcomes were evaluated with based on acromiohumeral distance (AHD) and stage of rotator cuff arthropathy. The status of fatty infiltration and graft was evaluated using magnetic resonance imaging. Outcomes were assessed preoperatively and at the final follow-up.

Results

Both groups showed improvement in clinical and radiological outcomes at the final follow-up. Group M demonstrated a higher improvement in ASES score (29.1 ± 15.8) than group C (18.1 ± 15.9, p = 0.006). Forward flexion and external rotation improved in group M (40 ± 26 and 11 ± 5, respectively) and group C (28 ± 23 and 6 ± 3, respectively; p = 0.003 and 0.004, respectively). Graft healing rate was significantly higher in group M (83.3%) than in group C (58.8%, p = 0.039) and AHD was significantly higher in group M (9.1 ± 2.4 mm) than in group C (6.3 ± 1.8 mm) at the final follow-up (p = 0.001). Subgroup analysis revealed that patients with graft failure generally showed progression of fatty infiltration without improvement in the stage of rotator cuff arthropathy. Patients with intact grafts demonstrated a more substantial improvement in functional outcomes (ASES score and forward flexion motion).

Conclusion

ASCR with mesh augmentation reduces graft failure rate as to restore superior shoulder joint stability.