Purpose
The purpose of the study was to investigate the rate and magnitude of return of active
forward elevation (aFE) of the arm for patients with severe preoperative elevation
dysfunction (less than 45° of aFE and termed profound pseudoparalysis) and massive, irreparable (or partially reparable) rotator cuff tears without arthritis
treated with arthroscopic superior capsular reconstruction (SCR).
Methods
The period for this retrospective study was October 2014 to October 2016. Inclusion
criteria included patients treated arthroscopically for an incompletely reparable
massive rotator cuff tear (2 tendons fully torn or tear dimension > 5 cm), preoperative
aFE of less than 45° (profound pseudoparalysis) with full passive elevation, an intact
or reparable subscapularis tendon, radiographic classification Hamada 0-3, and 12-month
clinical follow-up. The primary outcome measure was aFE (degrees) at 1 year postoperative.
Secondary outcomes included visual analog scale pain rating (0-10), American Shoulder
and Elbow Surgeons score, subjective shoulder value, and active external rotation.
Graft integrity and Goutallier grade of supraspinatus and infraspinatus at 1 year
postoperative were evaluated by magnetic resonance imaging.
Results
Ten patients met the inclusion criteria. Nine of 10 patients (90%) regained active
overhead use of the arm after SCR with preoperative aFE (mean ± standard error of
the mean [95% confidence interval (CI)]) 27° ± 2° [95% CI, 24°-30°] improving to postoperative
aFE 159° ± 15° [95% CI, 130°-187°; P < .0001]. All secondary outcome measures were also improved at 1 year postoperative
(visual analog scale, 4.6 ± 0.8 to 0.5 ± 0.2; P = .001; American Shoulder and Elbow Surgeons, 52 ± 6 to 89 ± 3; P = .0002; subjective shoulder value, 36 ± 3 to 91 ± 1; P < .0001; active external rotation, 24° ± 7° to 43° ± 8°; P = .002), and 7 of 10 SCR grafts were fully healed by MRI. No complications or reoperations
occurred.
Conclusions
Profound pseudoparalysis of the shoulder (active elevation less than 45°) in massive,
irreparable rotator cuff tears without arthritis was reversed in 90% of patients after
arthroscopic SCR. Reverse shoulder replacement has been proposed to be the only reliable
surgical option in this patient group, but SCR appears to be a valid joint-preserving
option for improving function with a low rate of complications.
Level of Evidence
Level IV, therapeutic case series.
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Article info
Publication history
Published online: October 30, 2018
Accepted:
July 9,
2018
Received:
January 3,
2018
Footnotes
See commentary on page 29
The authors report the following potential conflicts of interest or sources of funding: S.S.B. receives support from Arthrex and Wolters Kluwer Health-Lippincott Williams & Wilkins. R.U.H. receives support from Arthrex and Wolters Kluwer Health-Lippincott Williams & Wilkins. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Superior Capsular Reconstruction—Improved Superior Stability and Functional Deltoid Reverse Pseudoparalysis in Patients With Irreparable Rotator Cuff TearsArthroscopyVol. 35Issue 1
- PreviewSince I reported clinical and biomechanical improvement after superior capsular reconstruction (SCR) for irreparable rotator cuff tears in 2012 and 2013, many shoulder surgeons around the world have started to perform SCR. However, most of these surgeons are still on the learning curve, and their clinical results are not consistent because clinical outcomes after SCR are correlated with graft healing, which is affected by the surgeon's skill. In cases in which the graft does heal, active shoulder elevation increases after SCR even in patients with pseudoparalysis before surgery.
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