Purpose
To identify demographic, clinical, and radiographic factors associated with failure
after superior capsular reconstruction (SCR).
Methods
Prospectively collected data were analyzed from patients who underwent SCR using a
decellularized dermal allograft for an irreparable rotator cuff tear. Demographic
characteristics, radiographic findings, concomitant procedures, and patient-reported
outcomes (PROs) were recorded. Failure was defined by ≥1 of the following criteria:
(1) conversion to reverse total shoulder arthroplasty (RTSA), (2) a decrease in 1-year
postoperative shoulder-specific PROs compared with preoperative scores, or (3) patient
reports at final follow-up that the shoulder was in a worse condition than before
surgery. Preoperative variables were compared between patients meeting the criteria
for clinical failure and those who did not.
Results
Fifty-four patients (mean age 56.3 ± 5.8 years, range 45 to 70) who underwent SCR,
with minimum 1-year follow-up, were included in the analysis. Mean follow-up after
surgery was 24 months (range 12 to 53). Eleven patients (20.4%) met criteria for clinical
failure. Of the 11, 8 reported decreased American Shoulder and Elbow Surgeons (ASES)
or Constant scores or indicated that the operative shoulder was in a worse condition
than before surgery. Three patients underwent RTSA in the 6 to 12 months after SCR.
Female sex and the presence of a subscapularis tear were associated with failure (P = .023 and P = .029, respectively). A trend toward greater body mass index (BMI), lower preoperative
forward flexion, and lower preoperative acromiohumeral distance (AHD) was found in
patients with clinical failure (P = .075, P = .088, and P = .081, respectively). No other variable included in the analysis was significantly
associated with failure.
Conclusion
The proportions of female patients and those with subscapularis tear were greater
among patients with clinical failure after SCR. Greater BMI, lower preoperative forward
flexion, and lower preoperative AHD trended toward association with clinical failure
of SCR.
Level of Evidence
4, case series.
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References
- Massive tears of the rotator cuff.J Bone Joint Surg Am. 2010; 92: 1894-1908
- Massive rotator cuff tears: The result of partial rotator cuff repair.J Shoulder Elbow Surg. 2005; 14: 121-127
- Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical results, pathomechanics, and patient selection based on biomechanical parameters.Orthop Clin North Am. 1993; 24: 111-123
- Débridement of degenerative, irreparable lesions of the rotator cuff.J Bone Joint Surg Am. 1995; 77: 857-866
- Tuberoplasty: Creation of an acromiohumeral articulation—A treatment option for massive, irreparable rotator cuff tears.J Shoulder Elbow Surg. 2002; 11: 136-142
- Reversed arthroscopic subacromial decompression for massive rotator cuff tears.J Shoulder Elbow Surg. 2004; 13: 272-278
- Subscapularis transfer for reconstruction of massive tears of the rotator cuff.J Bone Joint Surg Am. 1996; 78: 239-245
- Transplantation of teres major muscle for infraspinatus muscle in irreparable rotator cuff tears.J Shoulder Elbow Surg. 1998; 7: 485-490
- Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears.J Bone Joint Surg Am. 2006; 88: 113-120
- Arthroscopic GraftJacket repair of rotator cuff tears.J Shoulder Elbow Surg. 2010; 19: 104-109
- Arthroscopic subacromial spacer implantation in patients with massive irreparable rotator cuff tears: Clinical and radiographic results of 39 retrospectives cases.Arthroscopy. 2017; 33: 1639-1644
- Reverse total shoulder arthroplasty for irreparable rotator cuff tears.Oper Tech Orthop. 2018; 28: 238-243
- Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.Arthroscopy. 2013; 29: 459-470
- Long head of the biceps as a suitable available local tissue autograft for superior capsular reconstruction: ‘The Chinese Way.Arthroscopy Tech. 2017; 6: e1559-e1566
- Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff repair.Arthroscopy Tech. 2016; 5: e1407-e1418
- Arthroscopic superior capsular reconstruction for treatment of massive irreparable rotator cuff tears.Arthroscopy Tech. 2015; 4: e637-e641
- All-arthroscopic superior shoulder capsule reconstruction with partial rotator cuff repair.Orthopedics. 2017; 40: e735-e738
- Superior capsule reconstruction technique using an acellular dermal allograft.Arthroscopy Tech. 2015; 4: e833-e839
- 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
- Arthroscopic superior capsular reconstruction for massive, irreparable rotator cuff tears: A systematic review of modern literature.Arthroscopy. 2019; 35: 1243-1253
- Return to sports and work after arthroscopic superior capsule reconstruction in patients with irreparable rotator cuff tears.Orthop J Sports Med. 2017; 5 (2325967117S2325900272)
- Arthroscopic superior capsule reconstruction eliminates pseudoparalysis in patients with irreparable rotator cuff tears.Orthop J Sports Med. 2017; 5 (2325967117S2325900119)
- Five-year follow-up of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.Orthop J Sports Med. 2019; 7 (2325967119S2325900194)
- Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft.Arthroscopy. 2018; 34: 93-99
- Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2205-2213
- Shoulder outcomes measures.J Am Acad Orthop Surg. 2010; 18: 436-444
- The pathogenesis and management of cuff tear arthropathy.J Shoulder Elbow Surg. 2018; 27: 2271-2283
- How to use a graft in irreparable rotator cuff tears: A literature review update of interposition and superior capsule reconstruction techniques.Curr Rev Musculoskel Med. 2018; 11: 122-130
- Superior capsular reconstruction: Indications, techniques, and clinical outcomes.J Bone Joint Surg Rev. 2018; 6: e10
- Establishing clinically significant outcome after arthroscopic rotator cuff repair.J Shoulder Elbow Surg. 2019; 28: 939-948
- Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears.J Bone Joint Surg Am. 2007; 89: 1184-1193
- Superior capsular reconstruction for massive rotator cuff tear leads to significant improvement in range of motion and clinical outcomes: A systematic review.Arthroscopy. 2019; 35: 1269-1277
- Shoulder superior capsular reconstruction: When a systematic review of a procedure can be misleading.Arthroscopy. 2019; 35: 1278-1279
- Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears.Arthroscopy. 2016; 32: 418-426
- Biomechanical role of capsular continuity in superior capsule reconstruction for irreparable tears of the supraspinatus tendon.Am J Sports Med. 2016; 44: 1423-1430
- Superior capsule reconstruction: Grafts for superior capsular reconstruction must be thick and stiff.Arthroscopy. 2019; 35: 2535-2536
- Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum two year follow up.Arthroscopy. 2020; 36: 1011-1019
- Rotator cuff repair: Published evidence on factors associated with repair integrity and clinical outcome.Am J Sports Med. 2015; 43: 491-500
- When do rotator cuff repairs fail? Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears.Am J Sports Med. 2011; 39: 2064-2070
Article Info
Publication History
Published online: September 26, 2020
Accepted:
September 19,
2020
Received:
February 10,
2020
See commentary on page 468Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.A.R. reports personal fees, Arthrex , Paragen Technologies; nonfinancial support, SAGE; personal fees and nonfinancial support, Saunders/Mosby-Elsevier, SLACK Inc. B.J.C. reports grants, personal fees, and nonfinancial support, Arthrex; other, Aesculap, Athletico, JRF Ortho, NIH , Smith & Nephew; personal fees and other, Elsevier, OTSM, Regentis; personal fees, Ossio. G.E.G. reports grants, Piedmont Orthopaedic Society; personal fees, DJO/Encore, Wright/Tornier, Mitek; fellowship funding, Smith & Nephew, Arthrex . N.N.V. reports other, AOSSM , JSES, Arthrex , Arthroscopy, AANA , Breg, Cymedia, Knee, Minivasive, Omeros, Orthospace, Ossur, SLACK Inc, Smith & Nephew, Vindico Medical-Orthopaedics Hyperguide, Wright Medical Technology. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
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© 2020 by the Arthroscopy Association of North America
