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Complications of Superior Capsule Reconstruction for the Treatment of Functionally Irreparable Rotator Cuff Tears: A Systematic Review

      Abstract

      Purpose

      The purpose of this systematic review is to characterize the complications associated with superior capsule reconstruction (SCR) for the treatment of functionally irreparable rotator cuff tears (FIRCTs).

      Methods

      This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two independent reviewers completed a search of PubMed, Embase, and Medline databases. Studies were deemed eligible for inclusion if they reported postoperative outcomes of arthroscopic SCR for FIRCTs and considered at least 1 postoperative complication. Statistical heterogeneity was quantified via the I2 statistic. Due to marked heterogeneity, pooled proportions were not reported. All complications and patient-reported outcomes were described qualitatively.

      Results

      Fourteen studies met the inclusion/exclusion criteria. The overall complication rate post-SCR ranged from 5.0% to 70.0% (I2 = 84.9%). Image-verified graft retear ranged from 8% to 70%, I2 = 79.4%), with higher rates reported when SCR was performed using allograft (19%-70%, I2 76.6%) compared to autograft (8%-29%, I2 = 66.1%). Reoperation (0%-36%, I2 = 73.4%), revision surgeries (0%-21%, I2 = 81.2%), medical complications (0%-5%, I2 = 0.0%), and infections (0%-5%, I2 = 0.0%) were also calculated.

      Conclusions

      SCR carries a distinct complication profile when used for the treatment of FIRCTs. The overall rate of complications ranged from 5.0% to 70.0%. The most common complication is graft retear with higher ranges in allografts (19%-70%) compared to autografts (8%-29%). The majority of studies reported at least 1 reoperation (range, 0%-36%), most commonly for revision to reverse shoulder arthroplasty.

      Level of Evidence

      Level IV, systematic review of Level IV or better investigations.
      Chronic massive rotator cuff tears are often disabling for patients and difficult to manage for surgeons. These tears account for up to 40% of all rotator cuff tears evaluated in clinic,
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      or superior capsule reconstruction (SCR).
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      ,
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      • Kwak J.-M.
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      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      However, there remains a paucity of data on the true complication profile following SCR for the treatment of FIRCTs. This information is essential to assist surgeons and patients in the surgical decision-making process when treating this difficult pathology. The purpose of this systematic review is to characterize the complications associated with SCR for the treatment of FIRCTs.
      We hypothesized that (1) SCR is associated with highly variable rates of complications, including graft retear, reoperation, and revision surgery; (2) SCR is a medically safe intervention; and (3) allograft and autograft studies have similar complication profiles.

      Methods

      This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
      • Moher D.
      • Liberati A.
      • Tetzlaff J.
      • Altman D.G.
      PRISMA Group
      Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.

      Search Strategy

      An English-language search of the PubMed (1966 to present), Embase (1947 to present), and Medline (1946 to present) databases was completed on May 5, 2020. Combinations of the terms “superior capsular reconstruction,” “tissue scaffold,” and “rotator cuff” were combined with the use of wildcard modifiers and medical subject headings (MeSH) such as “reconstructive surgical procedure” to identify relevant articles (Appendix 1). A secondary search was completed of the reference lists of the included studies as well as prior systematic reviews to ensure a complete data set was obtained.
      • Greenhalgh T.
      • Peacock R.
      Effectiveness and efficiency of search methods in systematic reviews of complex evidence: Audit of primary sources.
      Titles, abstracts, and full-text articles were reviewed independently by 2 investigators (M.S. and D.O.). If there was disagreement between the 2 reviewers, these were resolved by the senior author (J.W.).

      Inclusion Criteria

      Studies were deemed eligible for inclusion if they satisfied the following criteria: reported postoperative outcomes of arthroscopic SCR for irreparable rotator cuff tears and considered at least 1 postoperative complication. Case reports, review articles, editorials, commentary or gray literature source (ie, conference abstract or proceeding), animal or cadaveric studies, technique papers, and non-English-language publications were excluded. When multiple studies were published on the same patient cohort, all but 1 study (with the longest follow-up or most robust data set) representing that patient population were excluded.

      Data Extraction and Quality Analysis

      Data extraction was completed by 2 independent investigators (M.S. and S.Z.). Demographic data included the number of patients evaluated, patient age (mean and range), sex (proportion female), and length of follow-up (mean and range; Table 1). Preoperative parameters and clinical outcomes extracted included American Shoulder and Elbow Surgeons Shoulder score, pain as measured on a visual analog scale, Subjective Shoulder Value, Constant-Murley Shoulder Outcome Score (Constant), and radiographic or imaging outcomes as described by the authors. The surgical parameters analyzed included graft type (ie, dermal), graft source (autograft or allograft), graft thickness (mm), previous surgery and the number of tendons involved (supraspinatus, infraspinatus, subscapularis). The postoperative complications analyzed included graft retear, image verified graft retear, reoperation, revision surgery, infection, contracture, arthritis progression/humeral head elevation, persistent pain, thrombotic/pulmonary embolism (PE), and donor site morbidity.
      “Reoperation” was defined as any surgical intervention during postoperative follow-up. This consisted of both “revision surgery,” defined as an intervention performed to address a clinical failure of the procedure, and “other complications,” where surgery was performed leaving the SCR intact (eg, irrigation and debridement for infection, biceps tenodesis). The “image verified graft retear” rate included only studies that routinely performed postoperative magnetic resonance imaging (MRI) with greater than 80% of the patient population at a minimum of 6 months. Adverse outcomes were defined as unique negative outcomes reported by individual studies that did not required specific treatment or further investigation. Adverse outcomes were extracted and reported but were not included in the overall rate of complications.
      Following data extraction, assessment of methodologic quality of the included studies was completed by a single reviewer (M.S.) using the Methodological Index for Non-Randomized Studies.
      • Slim K.
      • Nini E.
      • Forestier D.
      • Kwiatkowski F.
      • Panis Y.
      • Chipponi J.
      Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument.
      This scale scores articles across 10 criteria compatible with the Consolidated Standards of Reporting Trials statement for randomized controlled trials yet allows for the inclusion of differing study designs (Table 3).
      • Schulz K.F.
      • Altman D.G.
      • Moher D.
      CONSORT Group
      CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials.

      Statistical Analysis

      A total complication rate was defined as the total number of complications divided by the total sample size for each study. Individual complication rates were calculated by the number of patients who experienced the complication against the total sample size of each study. Heterogeneity analysis was completed through consideration of the I2 statistic
      • Higgins J.P.T.
      • Thompson S.G.
      Quantifying heterogeneity in a meta-analysis.
      that ultimately precluded formal meta-analyses on complication proportions due to the high heterogeneity. Forest plots were generated for visual interpretation and ranges with the associated I2 statistic were presented in text for the complication proportions. All analyses were completed using StatsDirect software, version 3.2.8 (StatsDirect Ltd, BirkenHead, UK).

      Results

      A total of 414 studies met the search criteria, with 133 duplicates removed. Abstract screening of 281 studies resulted in 35 being considered for full-text review, and 19 studies were initially included (Fig 1). Mihata et al.
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      and Burkhart et al.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      were included, whereas Mihata et al.
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Five-year follow-up of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
      ,
      • Mihata T.
      • Lee T.Q.
      • Watanabe C.
      • et al.
      Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
      ,
      • Mihata T.
      • Lee T.Q.
      • Fukunishi K.
      • et al.
      Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears.
      and Burkhart et al.
      • Burkhart S.S.
      • Hartzler R.U.
      Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis.
      were excluded due to overlapping patient populations. The series reported by Burkhart et al.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      contributed patients to a multicenter prospective study by Denard et al.,
      • 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.
      accounting for a small proportion of the total cohorts, so both studies were ultimately included, resulting in a total of 14 studies in our analysis.
      Figure thumbnail gr1
      Fig 1Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram of the search process.
      • Moher D.
      • Liberati A.
      • Tetzlaff J.
      • Altman D.G.
      PRISMA Group
      Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
      Frequently reported complications following SCR included graft retear (graft rupture, anchor loosening), revision surgery, reoperation, and infection. Less commonly, patients experienced “other” complications such as stiffness or medical complications such as stroke or deep vein thrombosis. The overall rate of complications post-SCR ranged from 5.0% to 70.0% (I2 = 77.3%; Fig 2) (507 shoulders; Table 2).
      • 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.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      • 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.
      ,
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      The complication rate in the 8 studies using allografts (289 shoulders)
      • 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.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      • 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.
      ,
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      ,
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      ,
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      ranged from 5% to 70% (I2 = 84.9%) while the complication rate of the 4 studies using autografts (176 shoulders)
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      ,
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      ,
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      ranged from 14% to 32% (I2 = 42.1%).
      Table 1Demographics
      StudyStudy Population (Shoulders)Mean Age, y% FemaleMean Follow-up, mo% Follow-upGraft TypeGraft Thickness, mmStudy Design (Level of Evidence)MINORS Score
      Burkhart et al.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      4164.020.03489.0Dermal allograft3Retrospective case series (IV)6
      de Campos Azevedo et al.
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      2264.868.22395.5Fascia lata autograft5-8Prospective case series (IV)15
      Lacheta et al.
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      2256.042.925100.0Dermal allograft3Prospective case series (IV)13
      Denard et al.
      • 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.
      5962.033.91888.1Dermal allograft1, 2, and 3Multicenter prospective case series (IV)9
      Hirahara et al.
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      861.325.03289.0Dermal allograft1.5 and 3.5Prospective case series (NR)11
      Lee et al.
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      32 (36)60.931.32594.7Mixed>6 and <6Retrospective case control study (IV)12
      Lim et al.
      • Burkhart S.S.
      Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears: A suspension bridge model.
      3165.371.015100.0Fascia lata autograft≥6Retrospective case series (IV)14
      Mihata et al.
      • Mihata T.
      • Lee T.Q.
      • Fukunishi K.
      • et al.
      Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears.
      8866.2NR60NRFascia lata autograft6-8Retrospective case series (IV)9
      Ohta et al.
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      3575.348.641NRMixed autograft6-8Retrospective comparative study (NR)9
      Pennington et al.
      • 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.
      86 (88)59.439.012100.0Dermal allograft3Retrospective case series (IV)11
      Ravenscroft et al.
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      2760.0
      Given as a median age instead of mean.
      63.0NRNRDermal allograft3.5Histologic case study (NR)9
      Woodmass et al.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      3460.038.21252.3Dermal allograft3Retrospective case series (IV)9
      Badman et al.
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      1058.650.012
      Given as a minimum instead of mean.
      NRDermal allograftNRProspective case series (IV)10
      Yoon et al.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      659.50.027NRMixed2Retrospective case series (NR)11
      MINORS, Methodological Index for Non-Randomized Studies; NR, not reported.
      Given as a median age instead of mean.
      Given as a minimum instead of mean.
      Table 2Complications and Reoperations
      CitationShoulders (No.)Overall Complication Rates, % (No.)Graft Retear Rates, % (No.)Reoperation Rates, % (No.)Revision Surgery Rates, % (No.)Infection Rates, % (No.)“Other Complication” Rates, % (No.)Adverse Outcome Rates, % (No.)Medical Complication Rates, % (No.)
      Allograft studies
      Burkhart et al.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      4115% (6)10% (4)7% (3)5% (2)0% (0)2% (1)15% (6)2% (1)
      Lacheta et al
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      2245% (10)45% (10)5% (1)5% (1)0% (0)NRNRNR
      Denard et al.
      • 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.
      5922% (13)19% (11)18% (11)15% (9)2% (1)2% (1)32% (19)NR
      Hirahara et al.
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      850% (4)39% (3)25% (2)13% (1)NR12.5% (1)NRNR
      Pennington et al.
      • 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.
      885% (4)3% (3)1% (1)1% (1)NRNR1% (1)NR
      Ravenscroft et al.
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      2719% (5)19% (5)11% (3)11% (3)NRNRNRNR
      Woodmass et al.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      3435% (12)9% (3)24% (8)21% (7)NR26% (9)65% (22)NR
      Badman et al.
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      1070% (7)70% (7)NRNRNRNRNRNR
      Autograft studies
      Lim et al.
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      3132% (10)29% (9)NRNR0% (0)NRNR3% (1)
      Mihata et al.
      • Mihata T.
      • Lee T.Q.
      • Fukunishi K.
      • et al.
      Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears.
      8814% (12)23% (7)9% (8)NR2% (2)3% (3)1% (1)NR
      Ohta et al.
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      3523% (8)20% (7)11% (2)3% (1)0% (0)3% (1)NRNR
      de Campos Azevedo et al
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      2218% (4)9% (2)5% (1)NR5% (1)NR55% (12)5% (1)
      Mixed-graft studies
      Lee et al.
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      3636% (13)36% (13)36% (1)36% (13)NRNRNRNR
      Yoon et al.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      633% (2)17% (1)NRNR0% (0)33% (2)NRNR
      ∗In Hirahara et al.,
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      “glenoid fixation was obtained with 2 anchors and a double surgeon knot."
      Table 3Outcome Measurements


      Study
      Preoperative Mean–Postoperative Mean
      ASESPain VASSSVConstant Shoulder ScoreAHD, mm
      Burkhart et al.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      52.0-89.04.6-0.739.0-83.0NR7.0-8.0
      de Campos Azevedo et al
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      NRNR33.0-70.017.5-64.96.4-7.1
      Lacheta et al
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      54.0-83.94.0
      Reported as a median score.
      NRNR7.0-8.3
      Denard et al.
      • 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.
      43.6-77.55.8-1.735.0-76.3NR6.6-6.7
      Hirahara et al.
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      41.8-86.56.3-0.4NRNR4.5-7.7
      Lee et al.
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      50.3-82.75.8-1.3NR56.3-81.14.9-8.1
      Lim et al.
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      54.4-73.76.0-2.5NR51.7-63.75.3-6.4
      Mihata et al.
      • Mihata T.
      • Lee T.Q.
      • Fukunishi K.
      • et al.
      Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears.
      35.1-94.3NRNRNR4.4-9.5
      Ohta et al.
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      NRNRNR4.0-6.2
      Pennington et al.
      • 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.
      52.2-81.64.0-1.5NRNR7.1-9.7
      Ravenscroft et al.
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      NRNRNRNRNR
      Woodmass et al.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      NR4.9-5.026.6-45.8NRNR
      Badman et al.
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      43.0-87.06.5-1.0NRNR6.8-6.2
      Yoon et al.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      60.4-81.63.7-1.6NR59.9-63.04.8-3.8
      ADH, acromial humeral distance; ASES, American Shoulder and Elbow Surgeons Score; NR, not reported; SSV, Subjective Shoulder Value; VAS, visual analog scale.
      Reported as a median score.
      Fourteen studies reported graft retear, making it the most commonly reported complication associated with SCR.
      • 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.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      • 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.
      ,
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      The image-verified graft retear rate (8 studies, 271 shoulders) showed relatively higher rates of graft retear using allograft (19%-70%, I2 = 76.6%; Fig 3B ) when compared to those that used autografts (8%-29%, I2 = 66.1%; Fig 3C), respectively. The study by Lee et al.
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      was excluded from graft-type analyses due to the unclear delineation between patients receiving either graft type.
      Figure thumbnail gr3
      Fig 3Magnetic resonance imaging (MRI) graft retear. (A) Overall retear. (B) Allograft retear. (C) Autograft retear. ∗More than 80% patients receiving MRI at minimum 6 months postoperatively.
      Twelve studies reported reoperations (n = 53) with reoperation rates ranging from 0% to 36% (I2 = 73.4%; Fig 4A ).
      • 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.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      • 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.
      ,
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      ,
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      ,
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      Of the 53 reoperations, 38 were revision surgeries that consisted of 19 RSAs,
      • 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.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      • 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.
      ,
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      ,
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      ,
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      ,
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      4 revision SCRs,
      • 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.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      2 latissimus dorsi transfers (LDTs),
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      and 13 unspecified revisions
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      (Table 2). The rate of revision surgeries ranged from 0% to 21% (I2 = 81.2%; Fig 4B). Reoperation procedures included revision surgery for graft tear
      • 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.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      • 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.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      ,
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      and persistent shoulder pain,
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      ,
      • 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.
      removal of loose suture anchors,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      biceps tenodesis repair for biceps pain and tenodesis tear,
      • 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.
      ,
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      arthroscopic capsular release for shoulder contracture,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      arthroscopic debridement for infection and inflammatory synovitis,
      • 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.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      ,
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      and diagnostic arthroscopy
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      (Table 2). Two studies reported no reoperation surgeries.
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      ,
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      Figure thumbnail gr4
      Fig 4(A). Total reoperations. (B) Total revisions.
      Eight studies reported on infection,
      • 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.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      ,
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      ,
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      with 3 reporting at least 1 infection,
      • 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.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      while the other 5 reported zero infections.
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      ,
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      ,
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      ,
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      The overall rate for infection ranged from 0% to 5% (I2 = 0%). All 4 infections required reoperation with arthroscopic irrigation and debridement,
      • 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.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      ,
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      including the insertion of an antibiotic spacer for 1 patient (Table 2).
      • 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.
      Eight studies reported medical complications following SCR, with rates ranging from 0% to 5% (I2 = 0%).
      • 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.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      ,
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      ,
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      Of the 3 medical complications reported, there was 1 cerebrovascular accident (CVA),
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      1 PE,
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      and 1 deep vein thrombosis (DVT).
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      The CVA occurred in the immediate postoperative period and was due to withheld warfarin prior to the operation in a patient with a mechanical heart valve.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      The patient who developed a PE was successfully treated with anticoagulation and the patient with a DVT was described as experiencing “donor-site claudication,” for which no treatment was listed.
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      ,
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      Three studies reported “other” complications that were included in the overall complications data (Table 2).
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      ,
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      ,
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      These included shoulder dislocation,
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      infraspinatus retear,
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      and progressive arthritis.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      Five studies listed adverse outcomes that were not included in the overall complications. Adverse outcomes were unique to the individual study and required no treatment or further investigation.
      • 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.
      ,
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      ,
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      ,
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      These included reports of unsatisfactory outcomes,
      • 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.
      ,
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      clinical failure,
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      and harvest site pain/changes
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      ,
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      (Table 2). Unsuccessful clinical outcomes were reported by both Denard et al.
      • 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.
      and Burkhart et al.,
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      defined as less than a 17-point improvement in American Shoulder and Elbow Surgeons Shoulder score, with 19 of 59 and 6 of 41 patients experiencing an unsuccessful outcome, respectively. In comparison, Woodmass et al.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      reported 22 of 34 patients as clinical failures using the modified Neer classification. De Campos Azevedo et al.
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      described donor site–related morbidity, with 12 of 21 patients reporting harvest site pain and 16 of 21 patients reporting harvest site changes (eg, deformity, numbness, pain).

      Discussion

      SCR is associated with a highly variable rate of complications, ranging from 5.0% to 70%. The most common complication following SCR included image verified graft retear, with higher ranges among those treated with allografts (19%-70%) compared to those treated with autografts (8%-29%). Other complications included reoperation (0%-36%) and medical complications (0%-5%).
      FIRCTs represent a challenging pathology with multiple treatment options, including debridement and subacromial decompression,
      • Rockwood C.A.
      • Williams G.R.
      • Burkhead W.Z.
      Débridement of degenerative, irreparable lesions of the rotator cuff.
      ,
      • Burkhart S.S.
      Arthroscopic debridement and decompression for selected rotator cuff tears: Clinical results, pathomechanics, and patient selection based on biomechanical parameters.
      partial repair,
      • Burkhart S.S.
      Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears: A suspension bridge model.
      • Duralde X.A.
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      Massive rotator cuff tears: the result of partial rotator cuff repair.
      • Burkhart S.S.
      • Nottage W.M.
      • Ogilvie-Harris D.J.
      • Kohn H.S.
      • Pachelli A.
      Partial repair of irreparable rotator cuff tears.
      LDT or lower trapezius tendon transfer,
      • Gerber C.
      • Rahm S.A.
      • Catanzaro S.
      • Farshad M.
      • Moor B.K.
      Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: Long-term results at a minimum follow-up of ten years.
      ,
      • Wagner E.R.
      • Woodmass J.M.
      • Welp K.M.
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      Novel Arthroscopic tendon transfers for posterosuperior rotator cuff tears: Latissimus dorsi and lower trapezius transfers.
      ,
      • Elhassan B.T.
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      • Wagner E.R.
      Outcome of arthroscopically assisted lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tears.
      ,
      • Warner J.J.
      • Parsons I.M.
      Latissimus dorsi tendon transfer: A comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears.
      • Gerber C.
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      • Espinosa N.
      Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears.
      • Elhassan B.T.
      • Alentorn-Geli E.
      • Assenmacher A.T.
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      Arthroscopic-assisted lower trapezius tendon transfer for massive irreparable posterior-superior rotator cuff tears: Surgical technique.
      tissue augmentation,
      • Snyder S.J.
      • Arnoczky S.P.
      • Bond J.L.
      • Dopirak R.
      Histologic evaluation of a biopsy specimen obtained 3 months after rotator cuff augmentation with GraftJacket Matrix.
      • Bond J.L.
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      • Higgins J.
      • Burns J.
      • Snyder S.J.
      Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: Technique and preliminary results.
      • Badhe S.P.
      • Lawrence T.M.
      • Smith F.D.
      • Lunn P.G.
      An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears.
      and RSA.
      • Hartzler R.U.
      • Steen B.M.
      • Hussey M.M.
      • et al.
      Reverse shoulder arthroplasty for massive rotator cuff tear: Risk factors for poor functional improvement.
      ,
      • Samuelsen B.T.
      • Wagner E.R.
      • Houdek M.T.
      • et al.
      Primary reverse shoulder arthroplasty in patients aged 65 years or younger.
      ,
      • Favard L.
      • Levigne C.
      • Nerot C.
      • Gerber C.
      • De Wilde L.
      • Mole D.
      Reverse prostheses in arthropathies with cuff tear: Are survivorship and function maintained over time?.
      • Werner C.M.L.
      • Steinmann P.A.
      • Gilbart M.
      • Gerber C.
      Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis.
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      • Wieser K.
      • Gerber C.
      Long-term results of reverse total shoulder arthroplasty for rotator cuff dysfunction: A systematic review of longitudinal outcomes.
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      • Gerber C.
      Ek ETH
      Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: Results after five to fifteen years.
      Primary repair can result in high retear rates (often exceeding 50%) when used to treat FIRCTs
      • Malahias M.-A.
      • Kostretzis L.
      • Chronopoulos E.
      • Brilakis E.
      • Avramidis G.
      • Antonogiannakis E.
      Arthroscopic partial repair for massive rotator cuff tears: does it work? A systematic review.
      • Berth A.
      • Neumann W.
      • Awiszus F.
      • Pap G.
      Massive rotator cuff tears: Functional outcome after debridement or arthroscopic partial repair.
      • Heuberer P.R.
      • Kölblinger R.
      • Buchleitner S.
      • et al.
      Arthroscopic management of massive rotator cuff tears: An evaluation of debridement, complete, and partial repair with and without force couple restoration.
      while young age (<60) is an independent risk factor for poor functional improvement
      • Hartzler R.U.
      • Steen B.M.
      • Hussey M.M.
      • et al.
      Reverse shoulder arthroplasty for massive rotator cuff tear: Risk factors for poor functional improvement.
      and increased complications
      • Wagner E.R.
      • Houdek M.T.
      • Schleck C.D.
      • et al.
      The role age plays in the outcomes and complications of shoulder arthroplasty.
      following RSA. SCR was described by Mihata et al.
      • Mihata T.
      • Lee T.Q.
      • Watanabe C.
      • et al.
      Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
      in 2013 as a joint-preserving treatment option for patients with FIRCTs demonstrating promising postoperative clinical outcomes. Subsequent studies have reported highly variable rates of complications, including graft retears, reoperations, and revision surgeries.
      • Mihata T.
      • Lee T.Q.
      • Watanabe C.
      • et al.
      Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
      ,
      • Burkhart S.S.
      • Denard P.J.
      • Adams C.R.
      • Brady P.C.
      • Hartzler R.U.
      Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff repair.
      ,
      • Hirahara A.M.
      • Adams C.R.
      Arthroscopic superior capsular reconstruction for treatment of massive irreparable rotator cuff tears.
      This systematic review characterized the risk profile of SCR for the treatment of FIRCTs. A total of 14 studies (507 shoulders) met the study criteria, yielding an overall complications rate ranging from 5% to 70% (I2 = 77.3%).
      • 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.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      • 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.
      ,
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      ,
      • Mihata T.
      • Lee T.Q.
      • Hasegawa A.
      • et al.
      Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
      • Burkhart S.S.
      • Pranckun J.J.
      • Hartzler R.U.
      Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery.
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      • de Campos Azevedo C.I.
      • Ângelo A.C.L.P.G.
      • Vinga S.
      Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results.
      • Ohta S.
      • Komai O.
      • Onochi Y.
      Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear.
      • Hirahara A.M.
      • Andersen W.J.
      • Panero A.J.
      Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-Up.
      In the current study, graft retear was the most common complication following SCR, with at least 1 retear occurring in each of the 14 studies analyzed (5%-70%; Table 2). This high variability is at least partially explained by the differences in methodology and reporting. For instance, while some studies only imaged patients who presented with persistent pain or poor function, other studies performed routine MRI on 100% of their patients at final follow-up. In an effort to reduce this bias, an “image-verified graft retear” rate was calculated by evaluating only studies where >80% of patients had undergone a postoperative MRI at a minimum 6-month follow-up. The majority of studies demonstrated an image-verified graft retear rate of 20% or greater (Fig 3A). Variability in graft retear rates can also be explained by differences in fixation techniques utilized by the studies included in our analysis. For example, some studies found that anchor loosening primarily occurred at the glenoid,
      • Badman B.L.
      • Baessler A.M.
      • Moor M.
      Short-term clinical outcomes and comparison of ultrasound versus magnetic resonance imaging of superior capsular reconstruction.
      ,
      • Lacheta L.
      • Horan M.P.
      • Schairer W.W.
      • et al.
      Clinical and imaging outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears: A minimum 2-year follow-up.
      ,
      • Ravenscroft M.J.
      • Riley J.A.
      • Morgan B.W.
      • Sandher D.S.
      • Odak S.S.
      • Joseph P.
      Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.
      whereas while others found that loosening at the humeral side
      • 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.
      ,
      • Lim S.
      • AlRamadhan H.
      • Kwak J.-M.
      • Hong H.
      • Jeon I.-H.
      Graft tears after arthroscopic superior capsule reconstruction (ASCR): Pattern of failure and its correlation with clinical outcome.
      ,
      • Lee S.-J.
      • Min Y.-K.
      Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
      was more common. This variability can be attributed in part to differences in surgical technique. Although patients who experience a graft retear may demonstrate an improvement in pain and function when compared to their preoperative status, patients with healed SCR grafts demonstrate improved patient-reported outcomes at 2 years, highlighting the continued need to improve healing rates.
      • Burkhart S.S.
      • Hartzler R.U.
      Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis.
      Proposed risk factors for graft retear included graft type (allograft vs autograft) and thickness.
      • 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.
      ,
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      ,
      • Yoon J.Y.
      • Kim P.S.
      • Jo C.H.
      Clinical and radiological results after arthroscopic superior capsular reconstruction in patients with massive irreparable rotator cuff tears.
      When controlling for graft type, the range of image-verified graft retear was higher in patients who underwent an allograft reconstruction (19%-70%) when compared to autograft reconstructions (8%-29%). This may reflect graft incorporation with autograft tissue, allowing for more reliable integration and durability.
      • Woodmass J.M.
      • Wagner E.R.
      • Borque K.A.
      • Chang M.J.
      • Welp K.M.
      • Warner J.J.P.
      Superior capsule reconstruction using dermal allograft: Early outcomes and survival.
      ,
      • Athanasiou V.T.
      • Papachristou D.J.
      • Panagopoulos A.
      • Saridis A.
      • Scopa C.D.
      • Megas P.
      Histological comparison of autograft, allograft-DBM, xenograft, and synthetic grafts in a trabecular bone defect: An experimental study in rabbits.
      ,
      • Wang W.-M.
      • Ma X.-J.
      • Huang S.-B.
      • Ren L.-B.
      • Liu Y.-P.
      A comparative study of effect of autograft compared with allograft anterior cruciate ligament reconstruction on expressions of LOXs and MMPs.
      Athanasiou et al.
      • Athanasiou V.T.
      • Papachristou D.J.
      • Panagopoulos A.
      • Saridis A.
      • Scopa C.D.
      • Megas P.
      Histological comparison of autograft, allograft-DBM, xenograft, and synthetic grafts in a trabecular bone defect: An experimental study in rabbits.
      demonstrated that autografts show increased tissue incorporation on histologic analysis compared to allografts. Similarly, Wang et al.
      • Wang W.-M.
      • Ma X.-J.
      • Huang S.-B.
      • Ren L.-B.
      • Liu Y.-P.
      A comparative study of effect of autograft compared with allograft anterior cruciate ligament reconstruction on expressions of LOXs and MMPs.
      reported autografts to have superior maximum tensile strength with regard to soft tissue bone healing when compared to allografts. The difference in failure rates may also be attributed to the difference in graft thickness that typically parallels graft type. Currently, dermal allografts are available in thicknesses ranging from 1 to 3 mm.
      • 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.
      Conversely, iliotibial band autografts are harvested intraoperatively and typically shaped to measure 8 mm in thickness. Biomechanical data have demonstrated that 8-mm fascia lata autografts provide greater rotator cuff stability via a reduction in both superior peak contact pressure and superior translation, compared to 4-mm facia lata autografts.
      • Mihata T.
      • McGarry M.H.
      • Kahn T.
      • Goldberg I.
      • Neo M.
      • Lee T.Q.
      Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears.
      The importance of graft thickness is supported in clinical observation by Denard et al.,
      • 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.
      who reported that thinner grafts (1 mm) are more susceptible to failure (60%) when compared to reconstructions performed using thicker (3-mm) grafts (32%).
      Reoperations were reported in 83% of the included studies (range, 0%-36%) with revision surgery accounting for the majority of reoperations (Fig 4A,B). The most common revision surgery following SCR was RSA followed by revision SCR and LDT (Table 2). While the rate of reoperation is high, FIRCTs are a challenging pathology, and the alternative reconstructive interventions (rotator cuff repair, tendon transfer, RSA) share a similar reoperation profile. According to Duralde et al.
      • Duralde X.A.
      • Bair B.
      Massive rotator cuff tears: the result of partial rotator cuff repair.
      and Sperling et al.,
      • Sperling J.W.
      • Cofield R.H.
      • Schleck C.
      Rotator cuff repair in patients fifty years of age and younger.
      revision rates following arthroscopic repair of FIRCTs range from 2.9% to 24.1%. Even less successful outcomes are observed in patients who have undergone prior failed rotator cuff repair,
      • Bedi A.
      • Dines J.
      • Warren R.F.
      • Dines D.M.
      Massive tears of the rotator cuff.
      with 34.5% (128/371) of patients requiring revision surgery. Open LDT has slightly lower rates of reoperation
      • Gerber C.
      • Rahm S.A.
      • Catanzaro S.
      • Farshad M.
      • Moor B.K.
      Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: Long-term results at a minimum follow-up of ten years.
      and graft tear.
      • Boileau P.
      • Chuinard C.
      • Roussanne Y.
      • Neyton L.
      • Trojani C.
      Modified latissimus dorsi and teres major transfer through a single delto-pectoral approach for external rotation deficit of the shoulder: As an isolated procedure or with a reverse arthroplasty.
      • Gerhardt C.
      • Lehmann L.
      • Lichtenberg S.
      • Magosch P.
      • Habermeyer P.
      Modified L’Episcopo tendon transfers for irreparable rotator cuff tears: 5-year follow-up.
      • Lichtenberg S.
      • Magosch P.
      • Habermeyer P.
      Are there advantages of the combined latissimus-dorsi transfer according to L’Episcopo compared to the isolated latissimus-dorsi transfer according to Herzberg after a mean follow-up of 6 years? A matched-pair analysis.
      Gerber et al.
      • Gerber C.
      • Rahm S.A.
      • Catanzaro S.
      • Farshad M.
      • Moor B.K.
      Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: Long-term results at a minimum follow-up of ten years.
      described 8.7% (4/46) patients undergoing reoperation with a minimum 10-year follow-up. Gerhardt et al.
      • Gerhardt C.
      • Lehmann L.
      • Lichtenberg S.
      • Magosch P.
      • Habermeyer P.
      Modified L’Episcopo tendon transfers for irreparable rotator cuff tears: 5-year follow-up.
      published a 10.0% graft retear rate (2/20) when using solo LDT transfers while Lichtenberg et al.
      • Lichtenberg S.
      • Magosch P.
      • Habermeyer P.
      Are there advantages of the combined latissimus-dorsi transfer according to L’Episcopo compared to the isolated latissimus-dorsi transfer according to Herzberg after a mean follow-up of 6 years? A matched-pair analysis.
      described 0 of 20 patients with graft retears when using the modified L’Episcopo approach (latissimus dorsi and teres major transfer) after a 5-year follow-up. RSA is one of the primary methods used to treat massive irreparable rotator cuff tears.
      • Bedi A.
      • Dines J.
      • Warren R.F.
      • Dines D.M.
      Massive tears of the rotator cuff.
      ,
      • Burkhart S.S.
      • Hartzler R.U.
      Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis.
      ,
      • Tokish J.M.
      • Alexander T.C.
      • Kissenberth M.J.
      • Hawkins R.J.
      Pseudoparalysis: A systematic review of term definitions, treatment approaches, and outcomes of management techniques.
      Reoperation rates following RSA after a 15-year follow-up period are comparable to those following SCR at 1 to 2 years postoperatively
      • Ernstbrunner L.
      • Andronic O.
      • Grubhofer F.
      • Camenzind R.S.
      • Wieser K.
      • Gerber C.
      Long-term results of reverse total shoulder arthroplasty for rotator cuff dysfunction: A systematic review of longitudinal outcomes.
      with reoperation rates ranging from 5%
      • Boileau P.
      • Gonzalez J.-F.
      • Chuinard C.
      • Bicknell R.
      • Walch G.
      Reverse total shoulder arthroplasty after failed rotator cuff surgery.
      to 33%.
      • Werner C.M.L.
      • Steinmann P.A.
      • Gilbart M.
      • Gerber C.
      Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis.
      ,
      • Ernstbrunner L.
      • Andronic O.
      • Grubhofer F.
      • Camenzind R.S.
      • Wieser K.
      • Gerber C.
      Long-term results of reverse total shoulder arthroplasty for rotator cuff dysfunction: A systematic review of longitudinal outcomes.
      However, younger age is a risk factor for poor outcome, with the complication rate rising to 39% of patients who were under 60 years.
      • Ernstbrunner L.
      • Suter A.
      • Catanzaro S.
      • Rahm S.
      • Gerber C.
      Reverse total shoulder arthroplasty for massive, irreparable rotator cuff tears before the age of 60 years: Long-term results.
      Furthermore, reoperation following RSA may have a higher morbidity.
      • Ernstbrunner L.
      • Suter A.
      • Catanzaro S.
      • Rahm S.
      • Gerber C.
      Reverse total shoulder arthroplasty for massive, irreparable rotator cuff tears before the age of 60 years: Long-term results.
      Thus, in young patients without glenohumeral arthritis, joint-preserving treatment options remain the favored intervention.
      SCR is a relatively new and technically challenging intervention that has demonstrated a “surgeon learning curve,” where inexperienced surgeons observe a relatively inflated rate of complications while learning and optimizing their skills.