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Letter to Editor Regarding “Arthroscopic Superior Capsular Reconstruction for Massive, Irreparable Rotator Cuff Tears: A Systematic Review of Modern Literature”

      We wish to thank and congratulate Catapano et al.
      • Catapano M.
      • de Sa D.
      • Ekhtiari S.
      • Lin A.
      • Bedi A.
      • Lesniak B.P.
      Arthroscopic superior capsular reconstruction for massive, irreparable rotator cuff tears: A systematic review of modern literature.
      for their systematic review titled “Arthroscopic Superior Capsular Reconstruction for Massive, Irreparable Rotator Cuff Tears: A Systematic Review of Modern Literature.” In this article, they provide a systematic review of the efficacy and complications profile of superior capsular reconstruction as a technique to address massive, irreparable rotator cuff repairs. However, we do feel that there is one major limitation of this review that is not acknowledged in the “limitations paragraph” of the discussion. They state that “the combined clinical and radiographic failure and/or retear rate ranged from 3.4% to 36.1%” and that “graft tears did not differ significantly, with combined clinical and/or radiographic retear rates of 3.4% to 33.3% in patients with dermal allografts compared with 4.7% to 36.1% in those with TFL grafts.” We feel that it is of vital importance to appreciate that with a number of studies involving the dermal grafts, magnetic resonance imaging (MRI) was not performed in all patients in the majority of studies. We have previously highlighted that in the study of Pennington et al. that MRI was only performed in 4 of 88 patients.
      • Pennington W.T.
      • Bartz B.A.
      • Pauli J.M.
      • Walker C.E.
      • Schmidt W.
      Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: Short-term clinical outcomes and the radiographic parameter of superior capsular distance.
      ,
      • Narvani A.A.
      Regarding “Arthroscopic Superior Capsular Reconstruction With Acellular Dermal Allograft for the Treatment of Massive Irreparable Rotator Cuff Tears.
      MRI was only performed in patients who were either “dissatisfied or concerned of poor outcomes.” MRI failure rates may have been much greater if all patients (satisfied and dissatisfied) had postoperative MRI scans, as we know from previous publications that patients have significant improvement in their outcome scores despite a high rate of incomplete healing in the postoperative MRI.
      • Denard P.J.
      • Brady P.C.
      • Adams C.R.
      • Tokish J.M.
      • Burkhart S.S.
      Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft.
      Eighty-eight of the 350 patients of this review article were from the study of Pennington et al. (over 25%). Furthermore, the series by Pennington et al. comprises 48% (88 of 181) of total patients in this series where dermal allograft patch was used. The actual retear rate may be much greater, particularly in the dermal allograft patch group, had all patients in this review had an MRI postsurgery, whether clinically satisfied or not. This issue is not touched on in the discussion of this systematic review.
      Although we agree with the authors that superior capsular reconstruction provides good short-term clinical outcomes, we feel that one should be careful when interpreting statements such as “the combined clinical and radiographic failure and/or retear rate ranged from 3.4% to 36.1%, with failure and/or retears being reported in a total of 44 of 350 shoulders,” simply because not all the 350 patients had postoperative imaging. In addition, we feel that although short-term clinical outcomes may be similar between tensor fasciae latae and dermal graft, based on the studies shown in this systematic review, the same may not be concluded as far as retear rates. The proportion of patients who had MRI were much greater in the tensor fasciae latae group.

      Supplementary Data

      References

        • Catapano M.
        • de Sa D.
        • Ekhtiari S.
        • Lin A.
        • Bedi A.
        • Lesniak B.P.
        Arthroscopic superior capsular reconstruction for massive, irreparable rotator cuff tears: A systematic review of modern literature.
        Arthroscopy. 2019; 35: 1243-1253
        • Pennington W.T.
        • Bartz B.A.
        • Pauli J.M.
        • Walker C.E.
        • Schmidt W.
        Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: Short-term clinical outcomes and the radiographic parameter of superior capsular distance.
        Arthroscopy. 2018; 34: 1764-1773
        • Narvani A.A.
        Regarding “Arthroscopic Superior Capsular Reconstruction With Acellular Dermal Allograft for the Treatment of Massive Irreparable Rotator Cuff Tears.
        Arthroscopy. 2019; 35: 10-11
        • Denard P.J.
        • Brady P.C.
        • Adams C.R.
        • Tokish J.M.
        • Burkhart S.S.
        Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft.
        Arthroscopy. 2018; 34: 93-99