scholarly journals Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear

2019 ◽  
Vol 140 (10) ◽  
pp. 1319-1325
Author(s):  
Satoru Ohta ◽  
Osamu Komai ◽  
Yuuki Onochi
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Multiple Regression ◽  
Postoperative Outcomes ◽  
Rotator Cuff Tears ◽  
X Rays ◽  
Massive Rotator Cuff Tears ◽  
Superior Capsule Reconstruction ◽  
Stage 4 ◽  
Before And After

Abstract Introduction Superior capsule reconstruction (SCR) has been used for the tendon grafting of massive rotator cuff tears when primary repair is difficult. We examined the postoperative outcomes of SCR for massive rotator cuff tears and the risk factors for postoperative retear. Materials and methods Through this retrospective comparative study, we evaluated 35 patients with an average age of 75.3 (57–90) years who underwent SCR using the technique developed by Mihata et al. Clinical outcomes were evaluated 1 year postoperatively using the Japan Orthopedic Association (JOA) score, University of California Los Angeles (UCLA) shoulder score, elevation angle and the Sugaya classification, which uses a 5-point scale evaluation on magnetic resonance imaging in which types 4 and 5 are considered retears. We also investigated the progression of fatty degeneration before and after surgery and the rupture site of the graft. Acromio-humeral distance (AHD), before and after surgery was measured through X-rays. Rotator cuff tear-related shoulder arthritis was evaluated on plain X-rays using the Hamada stage. Risks of retear were identified using multiple regression analyses for sex, age, Hamada stage and JOA score. Results The JOA score improved from 62.3 ± 9.49 (SD) preoperatively to 84.6 ± 5.66 (SD) postoperatively (P < 0.001). The UCLA score improved from 15.3 ± 3.77 (SD) preoperatively to 30.1 ± 3.11 (SD) postoperatively (P < 0.001). AHD increased from 4.03 mm preoperatively to 6.23 mm postoperatively (P < 0.001). Postoperative retear was observed in seven of the 35 patients. Moreover, retear was observed in five of nine patients with a Hamada stage ≥ 4. Multiple regression analysis revealed that age ≥ 80 years, male sex and Hamada stage ≥ 4 were risk factors for retear. Conclusions While the postoperative outcomes of SCR are favorable, age, sex and degree of arthropathic change should be considered for surgical indications of SCR.

Preoperative Radiographic Risk Factors for Incomplete Arthroscopic Supraspinatus Tendon Repair in Massive Rotator Cuff Tears

2018 ◽  
Vol 34 (4) ◽  
pp. 1121-1127 ◽  
Author(s):  
Andrew J. Sheean ◽  
Robert U. Hartzler ◽  
Patrick J. Denard ◽  
Alexandre Lädermann ◽  
Timothy G. Sanders ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Tendon Repair ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears

scholarly journals Risk factors for retear of large/massive rotator cuff tears after arthroscopic surgery: an analysis of tearing patterns

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Hisao Shimokobe ◽  
Masafumi Gotoh ◽  
Hirokazu Honda ◽  
Hidehiro Nakamura ◽  
Yasuhiro Mitsui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Arthroscopic Surgery ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears

Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff Tears: Does It Make Sense? A Systematic Review of Early Clinical Evidence

2020 ◽  
Vol 48 (13) ◽  
pp. 3365-3375 ◽  
Author(s):  
Burak Altintas ◽  
Michael Scheidt ◽  
Victor Kremser ◽  
Robert Boykin ◽  
Sanjeev Bhatia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Clinical Evidence ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Current Evidence ◽  
Massive Rotator Cuff Tears ◽  
Superior Capsule Reconstruction

Background: Treatment of irreparable massive rotator cuff tears (MRCTs) in patients without advanced glenohumeral osteoarthritis remains a challenge. Arthroscopic superior capsule reconstruction (SCR) represents a newer method for treatment with increasing popularity and acceptance. Purpose: To analyze the clinical evidence surrounding SCR and determine the current clinical outcomes postoperatively. Study Design: Systematic review. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Electronic databases of PubMed, MEDLINE, Cochrane, and Google Scholar were used for the literature search. The study quality was evaluated according to the Modified Coleman Methodology Score. Studies in English evaluating SCR outcomes were included. Results: Seven studies were reviewed, including 352 patients (358 shoulders) treated with arthroscopic SCR with the mean duration of follow-up ranging from 15 to 48 months (range, 12-88 months). Fourteen patients were lost to follow-up, leaving 338 patients (344 shoulders) with clinical outcome data. Graft types included dermal allografts (n = 3 studies), fascia lata autografts (n = 3), or both (n = 1). Most commonly, a double-row technique was utilized for humeral graft fixation. The most common complication included graft tears in 13% of patients, resulting in 15 SCR revisions and 7 reverse shoulder arthroplasties. Postoperatively, improvements in visual analog scale (2.5 to 5.9), American Shoulder and Elbow Surgeons (20 to 56), Japanese Orthopaedic Association (38.0), Subjective Shoulder Value (37.0 to 41.3), and Constant (11.6 to 47.4) scores were observed. Three studies reported respective satisfaction rates of 72.9%, 85.7% and 90%. Increases in external rotation, internal rotation, and abduction with improved strength in external rotation were observed postoperatively. Improvement of pseudoparalysis was also observed in 3 studies. One study reported return to sports in 100% of patients (2 competitively, 24 recreationally) with no adverse outcomes. Conclusion: SCR showed good to excellent short-term clinical outcomes with adequate pain relief and functional improvement. The current evidence suggests that the procedure is an alternative for symptomatic patients with irreparable MRCT; however, the included studies were fair to poor in quality, and there were some notable complications. Long-term follow-up will determine the longevity and ultimate role of this new method in the treatment of irreparable MRCT.

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