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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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
