Purpose
To evaluate the preliminary clinical outcomes and complications of superior capsule
reconstruction (SCR) for irreparable rotator cuff tears.
Methods
A systematic review of PubMed, MEDLINE, EMBASE, and Cochrane databases was performed
using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Studies reporting clinical outcomes of irreparable rotator cuff tears managed by SCR
were included. Clinical outcome analyses of pre- and postoperative range of motion,
American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, and
acromiohumeral intervals (AHIs) were performed and reported as range or frequency.
Results
Five studies (285 patients, 291 shoulders) of level III-IV evidence were included,
with a weighted mean (± standard deviation) follow-up of 27.7 ± 17.3 months. Forward
flexion improved from 91°-130° preoperatively to 147°-160° postoperatively, external
rotation from 26°-41° to 41°-45°, and internal rotation from L4-L1 to L1. American
Shoulder and Elbow Surgeons scores increased from 36-52.2 to 77.5-92, and visual analog
scale pain scores decreased from 4.0-6.3 to 0.4-1.7. Radiographically, AHIs with acellular
dermal allograft ranged from 4.5 to 7.1 mm preoperatively, improving to 7.6-10.8 mm
immediately postoperation before decreasing to 6.7-9.7 mm by final follow-up. Complication
and graft failure rates were 17.2% and 11.7%, respectively.
Conclusions
Preliminary results of SCR show consistent improvement in shoulder functionality and
pain reduction. However, a decrease in postoperative AHIs indicates dermal allograft
elongation and persistent superior migration of the humerus, potentially contributing
to later graft failure. Studies with longer follow-up will be essential to evaluate
the long-term utility of SCR in the treatment of irreparable rotator cuff tears.
Level of Evidence
Level IV, systematic review of level III-IV studies.
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Article info
Publication history
Accepted:
February 24,
2019
Received:
November 14,
2018
Footnotes
See commentary on page 2535
The authors report the following potential conflicts of interest or sources of funding: No external funding was received for this study. B.O.P. receives support for consulting from Arthrex. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
This study was exempt from institutional review board review.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Superior Capsule Reconstruction: Grafts for Superior Capsular Reconstruction Must Be Thick and StiffArthroscopyVol. 35Issue 8
- PreviewTo achieve a good functional outcome, including minimal graft tear, after superior capsule reconstruction, surgeons should carefully compare the biomechanical properties of all graft materials under consideration. In particular, graft stiffness affects postoperative stability in the glenohumeral joint, acromiohumeral distance, and graft healing. In my experience, a sufficiently stiff fascia lata graft is 6- to 8-mm thick and includes suture reinforcement and/or an augmentation patch. I believe that augmenting acellular dermal allografts in a similar way will decrease the incidence of graft elongation, persistent superior migration of the humoral head, and other complications after superior capsule reconstruction.
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