Purpose
To evaluate the outcomes of arthroscopic superior capsular reconstruction (SCR) augmentation
of complete, massive rotator cuff repair (RCR).
Methods
A retrospective study of dermal allograft SCR-augmented RCRs performed by a single
surgeon from June 2016 through December 2017 was performed with the following inclusion
criteria: massive rotator cuff tear amenable to complete repair but with poor-quality
native rotator cuff tissue. Radiographic follow-up was performed at 1 year, and clinical
follow-up was performed at both 1 year and a minimum 2 years after surgery. Clinical
follow-up included the American Shoulder and Elbow Surgeons score, visual analog scale
score for pain, Subjective Shoulder Value score, active forward elevation, and external
rotation. Radiographs and magnetic resonance imaging (MRI) scans were assessed for
muscle quality using the Goutallier classification, and graft and cuff integrity was
assessed according to the Sugaya classification.
Results
The inclusion criteria were met by 24 patients at 1 year and by 18 (75%) at a minimum
of 2 years postoperatively. Patient-reported outcomes were improved compared with
preoperative data and were maintained at minimum 2-year follow-up, with median American
Shoulder and Elbow Surgeons scores of 42.5 (interquartile range [IQR], 30.8-58.7)
versus 93.9 (IQR, 82.4-100) (P < .001); median Subjective Shoulder Value scores of 30 (IQR, 20-50) versus 90 (IQR,
86.2-97.2) (P < .001); and median visual analog scale pain scores of 5.5 (IQR, 1-9) versus 0 (IQR,
0-0.8) (P = .001). Evaluation of graft and tendon healing on postoperative MRI revealed poor
interobserver agreement and showed 10 completely healed grafts (42%), 9 partially
healed grafts (38%), and 5 completely disrupted grafts (21%), with 42% of supraspinatus
tendons and 54% of infraspinatus tendons healed.
Conclusions
SCR with dermal allograft augmentation of complete RCR with poor-quality tissue shows
very good clinical outcomes at minimum 2-year follow-up. Poor interobserver agreement
regarding postoperative graft and rotator cuff integrity by MRI was found. The healing
rate for the SCR grafts was 79%. The rates of healing of the native supraspinatus
and infraspinatus tendons were 42% and 54%, respectively.
Level of Evidence
Level IV, retrospective case series.
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Article info
Publication history
Published online: November 13, 2021
Accepted:
November 4,
2021
Received:
June 13,
2021
See commentary on page 1420Footnotes
The authors report the following potential conflicts of interest or sources of funding: T.J.D. receives grants from Arthrex, outside the submitted work, and personal fees from Arthrex, Aesculap/Braun, and Musculoskeletal Transplant Foundation, outside the submitted work. R.U.H. is consultant for Stryker, outside the submitted work, and receives textbook publishing royalties from Wolters Kluwer Health–Lippincott Williams & Wilkins. S.S.B. is a consultant for Arthrex, outside the submitted work; receives royalties from Arthrex, outside the submitted work; has patents pending (US20170105716A1 and US20170189007A1); and receives textbook royalties from Wolters Kluwer Health–Lippincott Williams & Wilkins. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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