2017 ISAKOS Biennial Congress ePoster #2225

 

Arthroscopic Superior Capsular Reconstruction or Reverse Shoulder Arthroplasty in Irreparable Massive Rotator Cuff Tears? A Retrospective Comparative Study

Catarina Ângelo, MD, Lisbon PORTUGAL
Luis Sobral, MD, Lisboa PORTUGAL
Clara Azevedo, MD, Lisbon PORTUGAL

Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Lisboa, PORTUGAL

FDA Status Cleared

Summary

Arthroscopic superior capsular reconstruction and reverse shoulder arthroplasty seem to produce similar functional outcomes in the treatment of irreparable massive rotator cuff tears, though arthroscopic superior capsular reconstruction results in a less severe loss of active painless internal rotation in adduction.

Abstract

Arthroscopic superior capsular reconstruction may be a valid alternative to reverse shoulder arthroplasty in the treatment of irreparable massive rotator cuff tears, especially in young patients without evident arthritis. The aim of this study was to retrospectively compare the functional outcomes of reverse shoulder arthroplasty versus arthroscopic superior capsular reconstruction of patients with irreparable massive rotator cuff tears.
17 patients with massive rotator cuff tear documented by MRI were initially evaluated. Irreparability criteria were: tendon retraction (Patte stage II/III) and/or lipodystrophy (Goutallier stage 3 /4). Exclusion criteria were: infection and associated tendon transfer. 15 patients were included and divided into 2 groups according to the type of surgery: 8 underwent reverse shoulder arthroplasty (group 1) and 7 underwent arthroscopic superior capsular reconstruction with fascia lata autograft (group 2). The active painless postoperative range of motion (anterior elevation, abduction, internal and external rotation in adduction), cuff tear arthritis grade (Hamada classification), modified Constant score, Simple Shoulder Test (SST) and Subjective Shoulder Value (SSV) were retrospectively evaluated. Pre and postoperative painless active anterior elevation were prospectively measured. Statistical analysis: IBM SPSS Statistics® 22. Significance level set to 0.05.
There was no significant difference in the age (p=0.658), gender (p=0.119), dominance (p=0.622) or arthritis grade (p=0.616) between the two groups. The mean follow-up was 15 months in group 1 and 5 months in group 2, with a significant difference (p=0.011). There was a statistically significant increase in pre to postoperative painless active anterior elevation in both groups (p=0.009 in group 1; p=0.012 in group 2). Active postoperative internal rotation in adduction was higher in group 2 (p=0.008). Comparison between groups did not show significant differences in modified Constant score (p=0.572), SST (p=0.143), SSV (p=0.942), active painless abduction (p=0.275) or external rotation in adduction (p=0.837).
Both techniques seem to produce similar functional outcomes in the treatment of irreparable massive rotator cuff tears, though arthroscopic superior capsular reconstruction results in a less severe loss of active painless internal rotation in adduction than reverse shoulder arthroplasty. This can be an important advantage concerning patient’s personal hygiene and essential self-care. Nevertheless, more studies are needed to clarify the usefulness of arthroscopic superior capsular reconstruction in the treatment of rotator cuff tears.