Comparison of Superior Capsular Reconstruction and Partial Infraspinatus Repair: A Matched-Pair Analysis of Irreparable Rotator Cuff Tears

Background: Superior capsular reconstruction (SCR) represents a new option for the treatment of irreparable rotator cuff tears. Purpose/Hypothesis: This study aimed to evaluate the clinical and radiologic outcomes of SCR and compare them with the outcomes of partial repair (PR) of the infraspinatus tendon. The hypothesis was that there would be no significant differences between the clinical and radiologic outcome parameters of SCR and PR after a minimum follow-up of 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Of 21 patients who underwent SCR, 20 patients were matched in a 1:1 ratio according to sex, age, and tear configuration with 20 of 60 patients who had undergone PR; all patients were prospectively evaluated for a minimum follow-up of 2 years. The investigated outcome measures included the Constant score; Western Ontario Rotator Cuff (WORC) index; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiologic analysis of acromiohumeral distance (AHD) and humeral head centralization (HHC). Results: There were no differences in the demographic data between the SCR and PR groups. The mean age of both groups was 62.3 years (range, 47-79 years), the mean tear configuration was Bateman 3.0 and Patte 2.8, and the mean follow-up period was 29.4 months (range, 24-53 months). At final follow-up, no significant differences were seen between the SCR and PR groups with regard to Constant score (77.1 vs 82.7), age- and sex-adapted Constant score (85.5% vs 91.4%), DASH score (15.6 vs 7.8), or WORC index (81.1 vs 90.4). No significant differences in the AHD or HHC were seen between the groups. The reoperation rate was 4.8% (1/21) in the SCR cohort and 15% (9/60) in the PR cohort. Conclusion: Both SCR and PR resulted in significant improvements in patient-reported outcomes at 2-year follow-up, with no significant differences in clinical outcomes between the 2 techniques. Further follow-up is needed to determine whether there are long-term differences in HHC and development of cuff tear arthropathy. Further investigations should also focus on the cost-effectiveness of the respective procedures.

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Arthroscopic Superior Capsular Reconstruction in Males Provides Superior Outcomes to Reverse Total Shoulder or Debridement for Irreparable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00101 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0010

Author(s):

John M. Tokish ◽

Michael J. Kissenberth ◽

Ellen Shanley ◽

Stefan John Tolan ◽

Kyle J. Adams ◽

...

Keyword(s):

Rotator Cuff ◽

Patient Reported Outcomes ◽

Rotator Cuff Tears ◽

Preliminary Results ◽

Biceps Tenotomy ◽

Superior Capsular Reconstruction ◽

Patient Reported ◽

Male Patients ◽

Reverse Total Shoulder

Objectives: Early results following arthroscopic superior capsular reconstruction(SCR) in patients with massive, irreparable rotator cuff tears are promising. However, no studies have compared patient reported outcomes between SCR or reverse total shoulder(rTSA) and rotator cuff debridement for these patients. Therefore, the purpose of this study was to compare 1-year outcomes between patients with massive irreparable rotator cuff tears who underwent a SCR, rTSA, or rotator cuff debridement with a concurrent biceps tenotomy or tenodesis. Methods: Patients(n=63) who underwent either SCR(n=21), rTSA(21), or cuff debridement(n=21) and biceps tenotomy or tenodesis for a massive, irreparable rotator cuff tear treated with a minimum 1-year follow up were retrospectively reviewed. Age, sex, BMI, smoking status, Charlson Index, Hamada classification, and ASES scores were recorded and compared using a multivariate ANOVA were used to compare between surgical approaches. A Chi Square analyses were used to compare sex distribution and the Charlson Deyo Index between groups (α=0.05). Results: Overall, patients across the 3 groups were not statistically different in age or follow up ASES score at minimum 14 month follow up ( P> 0.05). There was a significant interaction effect between surgery group and sex (P=0.02) on ASES score but not age ( P=0.08). Univariate F tests revealed that male patients who received an SCR displayed a 10-14% better outcome at follow up compared to other groups (Table 1) which exceeds the reported ASES score MCID. Conclusion: Our results show comparable results across surgical options for massive irreparable cuff tears with good patient reported outcomes. Male patients displayed clinically important greater ASES scores at 1 year follow up. Future studies should evaluate these preliminary results to assess if these preliminary results hold up at longer follow up times.

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Short-term results (1 year) of vented versus solid polyetheretherketone anchors in treatment of rotator cuff tears

SICOT-J ◽

10.1051/sicotj/2019026 ◽

2019 ◽

Vol 5 ◽

pp. 32

Author(s):

Marco C. Sarmento ◽

António E. Cartucho ◽

Jacinto M. Monteiro

Keyword(s):

Rotator Cuff ◽

Constant Score ◽

Healing Process ◽

Randomized Study ◽

Rotator Cuff Tears ◽

First Year ◽

Dash Score ◽

Short Term ◽

Cuff Tear

Background: Due to the rotator cuff retear after being surgically repaired, some strategies have been developed. The authors verified that the possibility of polyetheretherketone (PEEK) vented anchors promoted a better clinical and healing process than PEEK solid anchors. Methods: A prospective and randomized study was designed with 38 patients treated with PEEK anchors, 18 of whom with vented anchors and 20 with solid ones. Demographic, clinical and radiologic data were collected before and during surgery (time 0) and at 12 months of follow-up. Results: In the final follow-up (12 months), there was no difference in the visual analogic scale (VAS) scale between groups (1.7 points vs 1.9 points; p = 0.731), neither in the DASH score (34.2 points vs 23.9 points; p = 0.268), nor in absolute Constant score (76.9 points vs 77.3 points; p = 0.910). In MRI, 10 patients had their cuff tear healed in the vented group and 15 in the solid group (p = 0.173). Conclusion: The new designed vented anchors do not add any advantage when compared to solids ones, at least within the first year after surgery.

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Treatment of rotator cuff tears with arthroscopic transosseous technique: results of the first twenty cases

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00060 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0006

Author(s):

Ahmet Fırat ◽

Osman Tecimel ◽

Ali Şahin ◽

Şahin Çepni

Keyword(s):

Rotator Cuff ◽

Surgical Technique ◽

Constant Score ◽

Early Period ◽

Rotator Cuff Tears ◽

Vas Score ◽

Pull Out ◽

Biceps Tenotomy ◽

The Mean

Purpose: The aim of this study was to evaluate the results of our first 20 cases of rotator cuff tear treated with arthroscopic transosseous technique Methods: Patients with supraspinatus and infraspinatus extended supraspinatus tears were included. Local etchical board acceptance was obtained. Surgical technique was trained with model and cadaver. Surgical technique was done using transosseous implant Sharc-FT (NCS Lab, Carpi, Italy) with arthroscopy. Acromyoplasty in all patients, subscapularis repair in 2 patients, biceps tenotomy in 4 patients, biceps tenodesis in 6 patients and acromyoclavicular coplanning in 6 patients were performed. During postoperative period, the standart rehabilitation protocol was performed. Prospectively collective datas were evaluated retrospectively. Outcomes were measured with surgery time, VAS score and Constant score at the preoperative period and the last follow-up. Rerupture was evaluated with magnetic resonance at the last follow-up. Results: The mean age was 52,2 (39-64) and follow-up was 16,4 month (14-20). Fifthteen of patients were female. The mean surgery time was 72 min (38-124). VAS score was 6.6±0.4 preoperatively and 1.6±0.5 at the last follow up. Constant score was 58.4±3.2 preoperatively and 84.4±3.8 at the last follow up. Statistically significant differences were determined. Two reruptures (%10) were determined. One patient with superficial infection was treated using antibioteraphy. Conclusions: The implant that we used in this study allows transosseous repair of rotator cuff with cortical fixation. Pull out problem that is seen with anchors is elaminated with this technique. We determined our results were satisfactory at the early period. But we think that bone-tendon healing need to be evaluated with long follow-up studies. [Figure: see text]

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Latissimus Dorsi Tendon Transfer with or Without Superior Capsular Reconstruction for Treatment of Irrepairable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00100 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0010

Author(s):

Anthony F. De Giacomo ◽

Hithem Rahmi ◽

Sevag Bastian ◽

Christopher Klein ◽

John Itamura

Keyword(s):

Rotator Cuff ◽

Latissimus Dorsi ◽

Tendon Transfer ◽

Rotator Cuff Tears ◽

Dash Score ◽

Vas Score ◽

Superior Capsular Reconstruction ◽

Significant Difference ◽

Secondary Outcomes

Objectives: Treatment options for massive irreparable rotator cuff tears, in middle aged adults, consists of tendon transfer or superior capsular reconstruction (SCR). The purpose of this study was to evaluate if transfer of the latissimus dorsi tendon transfer is enhanced with combination of superior capsular reconstruction for treatment of massive irreparable rotator cuff tears. Methods: At a single institution, all consecutive patients undergoing transfer of the latissimus dorsi tendon with or without superior capsular reconstruction, between 2013 and 2016, for treatment of irreparable rotator cuff tears were evaluated. SCR, was indicated, in addition to latissimus transfer, for patients with impaired preoperative active abduction. All clinical notes, diagnostic imaging, and operative reports were reviewed in detail. Demographics, operative techniques, and radiographic parameters were collected and measured. Functional outcome scores were prospectively collected from patients. The primary outcome of the study was the Disability of Arm, Shoulder, Hand (DASH) score. The secondary outcomes of the study were the Visual Analog Scale (VAS) pain score, Single Assessment Numeric Evaluation (SANE) score, and the American Shoulder and Elbow Society (ASES) score. Results: At 3 years, there were a total of 26 latissimus dorsi tendon transfers performed in patients with irreparable rotator cuff tears. Of these, 8 patients underwent only latissimus dorsi tendon transfer and 18 patients underwent latissimus dorsi tendon transfer combined with a superior capsular reconstruction. Average age was 53 years old with the majority of patients being male (88%). The dominant extremity was involved in 22 (85%) of latissimus transfers and 14 (53%) of patients had previous surgery to address a rotator cuff tear. Follow-up, for the entire cohort, was on average 29 months. At final follow-up, there was no significant difference in physical examination or radiographic measurements between patients with latissimus transfer alone and those with latissimus transfer with SCR. All patients, undergoing either technique, showed significant improvement in both the DASH score (preoperative DASH=59.6, postoperative DASH=39.9, P=0.049) and VAS score (preoperative VAS=6.6, postoperative VAS=3.3, P=0.0006). However, those patients undergoing revision surgery, regardless of technique, showed significantly less improvement in the DASH score (P=0.005), VAS score (P=0.002), SANE score (P=0.005), and the ASES score (P=0.001). Transfer of the Latissimus tendon with SCR, in comparison to only tendon transfer, did not show any significant difference in the final DASH score (p-value=0.72). At the same time, there was no significant difference between latissimus transfer, with or without SCR, in the secondary outcomes of the VAS score(P=0.97), the SANE score(P=0.63), or the ASES score (P=0.74). Conclusion: This is the first study to report the outcomes of latissimus dorsi tendon transfer with superior capsular reconstruction in comparison to only latissimus dorsi tendon transfer for treatment of irreparable rotator cuff tears. The study suggests that transfer of the latissimus dorsi tendon in combination with superior capsular reconstruction, at short term follow-up of 2 years, may not significantly influence functional outcome. Rather, patients undergoing revision surgery, regardless of technique, may demonstrate smaller improvements in functional outcomes. [Table: see text][Table: see text]

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Latissimus Dorsi Tendon Transfer Vs. Superior Capsular Reconstruction for Treatment of Irreparable Massive Rotator Cuff Tears: A Retrospective Comparison Study with Short-Term Clinical Results

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00382 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0038

Author(s):

Tiffany Kadow ◽

Daniel Garcia ◽

Rebecca Minorini ◽

Mark Baratz ◽

Ruth Delaney ◽

...

Keyword(s):

Rotator Cuff ◽

Patient Reported Outcomes ◽

External Rotation ◽

Rotator Cuff Tears ◽

Short Term ◽

Forward Flexion ◽

Massive Rotator Cuff Tears ◽

Superior Capsular Reconstruction ◽

Patient Reported

Objectives: Irreparable massive rotator cuff tears, particularly those that occur in younger patients, represent a particularly challenging clinical scenario with limited options. Treatments such as reverse total shoulder arthroplasty are typically not well indicated for this patient population. We compared two treatment methods, latissimus dorsi tendon transfer (LDTT) vs arthroscopic superior capsular reconstruction (SCR), to determine if one is superior to the other regarding improvement in range of motion (ROM) and patient reported outcomes (PROs). We hypothesize that both treatments would have similar outcomes regarding functional restoration and subjective outcomes. Methods: A retrospective cohort study assessed 43 patients with an irreparable posterosuperior rotator cuff tear after failed conservative or surgical treatment who underwent either LDTT (14 patients, 16 shoulders) or SCR (27 patients, 27 shoulders). Patients with a minimum of 6 month follow-up were included (mean follow up: 17.9 months, 14.9 months respectively). Changes in preoperative and postoperative forward flexion and external rotation were evaluated. Patient reported outcomes (PROs) including ASES, VAS, and SSV were assessed. T-test and Chi-Square statistical tests were performed. Results: The mean age at the time of surgery was 59.9yo vs 60yo for LDTT and SCR respectively (p=0.98). There were significantly more patients in the LDTT group that had undergone prior rotator cuff surgery (p<0.005) and significantly greater number of patients who had subscapularis tears which required repair in patients that underwent SCR (p<0.01). There was no difference in gender (p=0.75). Both cohorts demonstrated similar improvement in forward flexion with mean active forward flexion improving from 123° (90-160°) pre-operatively to 139° (80-180°) postoperatively in the LDTT group (p=0.157) and 85° (0-170°) preoperatively to 138° (40-175°) postoperatively in the SCR group (p =0.001). The average improvement in forward flexion was significantly greater in the SCR group with an improvement of 52° for SCR vs 14° for LDTT (p=0.035). External rotation improved in the LDTT cohort from 41° preoperatively (10-60°) to 62° (10-80°) (p=0.032) while external rotation stayed unchanged for the SCR cohort with 43° preoperatively (0-70°) to 44° (20-80°) postoperatively (p=0.868). The improvement in external rotation was significantly greater in the LDTT cohort with improvement of 19° vs 0.5° in the SCR group (p=0.011). There was no significant difference in reported ASES scores (LDTT: 65.6 vs SCR:70.9)(p=0.569), VAS (LDTT:1.78 vs SCR 2.26) (p=0.645), or SSV (LDTT:55 vs SCR:72.6) (p=0.087). Conclusion: LDTT and SCR both result in functional improvement of motion with SCR improving forward flexion to a greater extent and LDTT improving external rotation to a greater extent. Patient reported outcomes are similar between the two groups at short term follow up. Longer term outcomes are necessary before determining whether one treatment is optimal over the other as well as establishing the appropriate indications for each. [Table: see text]

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Massive Rotator Cuff Tear Bridging Reconstruction Using Acellular Dermal Matrix: Mid-term Results (219)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00327 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0032

Author(s):

Moayd Awad ◽

Sara Sparavalo ◽

Jie Ma ◽

Ivan Wong

Keyword(s):

Rotator Cuff ◽

Total Shoulder Arthroplasty ◽

Acellular Dermal Matrix ◽

Rotator Cuff Tears ◽

Dermal Matrix ◽

Massive Rotator Cuff Tears ◽

Superior Capsular Reconstruction ◽

Patient Reported ◽

Reverse Total Shoulder

Objectives: Management of massive rotator cuff tears remains a challenge despite development of different surgical techniques. Bridging reconstruction was developed to improve clinical outcomes and to avoid the morbidity associated with tendon transfers and arthroplasty. To date, there have been no studies assessing the mid-term clinical outcome for patients undergoing this procedure. The objective of this study was to evaluate the mid-term clinical outcomes of patients who underwent bridging reconstruction using acellular dermal matrix for large/massive rotator cuff tears (> 3 cm). Methods: A retrospective chart review was conducted for patients who underwent bridging reconstruction between 2010 and 2018 by one surgeon (IW). Patients with a minimum follow-up of two years were included. All patients completed self-reported questionnaires (Western Ontario Rotator Cuff (WORC) Index and the Disabilities of the Shoulder, Arm and Hand (DASH) score) pre-operatively and post-operatively at six months, one year and annually thereafter. Results: One hundred charts were reviewed, and 20 patients were excluded due to lack of pre- or post-operative outcome scores. This cohort of patients consisted of 80 patients mean age of 58.6 ± 9.1 years and an average follow-up of 5.1 ± 1.6 years. The mean pre- and post-operative WORC scores (± SD) were 61.4 ± 20.6 and 28.1 ± 25.5 (p < 0.001), respectively. The mean pre- and post-operative DASH scores were 52.2 ± 19.7 and 23.1 ± 22.4 (p < 0.001), respectively. There was an improvement in WORC and DASH over time with the most significant improvement during the first year post-operatively (Figure 1). Seventy-eight percent of patients met the minimal clinically important difference (MCID) for WORC while 77% of patients met the MCID for DASH. Our results show significant mid-term clinical improvement in WORC and DASH scores that is similar to previously published data that showed significant improvements in other patient-reported outcome scores. We believe these positive outcomes to be a result of better force coupling within the shoulder as compared to other surgical treatments such as maximal repair, superior capsular reconstruction, and reverse total shoulder arthroplasty. Conclusions: Arthroscopic bridging reconstruction for the treatment of massive rotator cuff tears results in significant improvement of patient reported outcomes (as measured using the WORC and DASH scores) at a mean follow up of five years. This may suggest that bridging reconstruction is a good treatment alternative as compared to superior capsular reconstruction or reverse total shoulder arthroplasty. Longer follow-up with a prospective study design is necessary to determine the longevity of these outcomes.

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Primary versus revision arthroscopic bridging reconstruction using dermal allograft: a clinical and radiographic analysis (243)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00351 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0035

Author(s):

Ivan Wong ◽

Sara Sparavalo ◽

Jie Ma ◽

Nedal Alkhatib

Keyword(s):

Rotator Cuff ◽

Muscle Atrophy ◽

Fatty Infiltration ◽

Rotator Cuff Tears ◽

Primary Group ◽

Dash Score ◽

Massive Rotator Cuff Tears ◽

Western Ontario Rotator Cuff ◽

Goutallier Classification

Objectives: Large or massive rotator cuff tears make up between 10-40% of all rotator cuff tears, yet there is no agreement on the best treatment. Previous studies have shown that acellular human dermal allograft (AHDA) can be used for bridging reconstruction with positive patient outcomes. The use of this surgical technique has not been extensively studied in the primary or revision surgical setting. The main objective of this study was to compare the clinical and radiographic outcomes of patients who received primary or revision arthroscopic bridging reconstruction. Methods: This study is a retrospective review of a sequential series of patients who underwent arthroscopic bridging reconstruction (ABR) using AHDA by the primary author (IW). A total of 130 patients underwent ABR between 2010 and 2018. The inclusion criteria were patients with completed Western Ontario Rotator Cuff (WORC) questionnaire, Disabilities of the Arm, Shoulder, and Hand (DASH) score, or both pre-operatively and at multiple post-operative timepoints. Patients with missing WORC scores were excluded from the study. Eighty-three patients were included following chart review. Patients with available post-operative MRIs were also used for radiological assessment by an independent MSK-trained radiologist. Post-operative MRIs were reviewed to assess for graft integrity and changes to rotator cuff muscle atrophy (using the Warner classification) and fatty degeneration (using the Goutallier classification). Results: There were 46 patients who received primary ABR and 37 who received revision ABR. Forty-eight patients had a post-operative MRI available for review (Primary: 25; Revision: 23). The demographics are summarized in Table 1. Both groups showed a significant improvement in WORC score post-operatively (p<0.001). Primary ABR resulted in higher post-operative WORC scores as compared to revision ABR (p=0.015; Figure 1). The incidence of complete re-tears in the primary group was 8% and 17.4% in the revision group. More than 35% of patients in the primary group showed improvement in fatty infiltration of the infraspinatus and supraspinatus muscles. There was a higher progression in muscle atrophy in the revision group as compared to the primary group (74% and 30%, respectively). Conclusions: Arthroscopic primary arthroscopic bridging reconstruction for large/massive rotator cuff tears using acellular human dermal allograft had better improvement in their WORC scores compared to revision group at the final follow-up. Although the revision group had improved at the two-year follow-up, these changes in WORC score were not sustained at the final follow-up while the improvements were maintained for the primary group. The primary group had a smaller re-tear rate, better fatty infiltration and muscle atrophy as compared to the revision group. This suggests that primary bridging reconstruction provides better outcomes than a revision surgery.

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Deltoid muscular flap transfer for the treatment of irreparable rotator cuff tears

Orthopedic Reviews ◽

10.4081/or.2009.e15 ◽

2009 ◽

Vol 1 (1) ◽

pp. 15 ◽

Cited By ~ 4

Author(s):

Justus Gille ◽

Joerg Suehwold ◽

Arndt-Peter Schulz ◽

Benjamin Kienast ◽

Andreas Unger ◽

...

Keyword(s):

Rotator Cuff ◽

Constant Score ◽

Muscle Flap ◽

Rotator Cuff Tears ◽

Daily Routine ◽

Simple Method ◽

Mean Values ◽

Flap Transfer ◽

The Mean

The purpose of this study was to evaluate the outcome of deltoid muscle flap transfer for the treatment of irreparable rotator cuff tears. In a retrospective study 20 consecutive patients were evaluated. The index procedure took place between 2000 and 2003. Fifteen patients were male, mean age was 62 years. Inclusion criterion was a rotator cuff defect Bateman grade IV. Exclusion criteria were smaller defects, shoulder instability and fractures of the injured shoulder. An open reconstruction with acromioplasty and a pedicled delta flap was performed. Follow up period was mean 42 months. Follow-up included clinical examination, Magnetic Resonance Imaging (MRI) and the Constant and Simple (CS) shoulder tests. According to the Constant shoulder test the results were good in 13 patients, fair in 5 and unsatisfactory in 2. The pre-operative Constant Score improved from mean 25.7 points (±5.3) to 72.3 (±7.8) at follow-up. The mean values for the subcategories of CS increased significantly from 3.9 to 14.4 points for pain and from 4.2 to 15.9 points for activities daily routine (p<0.05). The change in range of motion and strength were not significant (p>0.05). Results of the Simple Shoulder Test showed a significant increase of the mean values from pre-operative 4.3 to 14.7 points post-operatively. MRI showed a subacromial covering of the defect in all cases, all flaps where intact on MRI but always the flap showed marked fatty degeneration. In conclusion, the delta flap is a simple method for the repair of large defects of the rotator cuff leading to satisfying medium results.

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Reverse shoulder arthroplasty for type 1 sequelae of a fracture of the proximal humerus

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0947.r1 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 318-323 ◽

Cited By ~ 20

Author(s):

P. Raiss ◽

G. Alami ◽

T. Bruckner ◽

P. Magosch ◽

P. Habermeyer ◽

...

Keyword(s):

Rotator Cuff ◽

Proximal Humerus ◽

External Rotation ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Rotator Cuff Tears ◽

The Mean ◽

Rotator Cuff Deficiency

Aims The aim of this study was to analyze the results of reverse shoulder arthroplasty (RSA) in patients with type 1 sequelae of a fracture of the proximal humerus in association with rotator cuff deficiency or severe stiffness of the shoulder. Patients and Methods A total of 38 patients were included: 28 women and ten men. Their mean age at the time of arthroplasty was 73 years (54 to 91). Before the RSA, 18 patients had been treated with open reduction and internal fixation following a fracture. A total of 22 patients had a rotator cuff tear and 11 had severe stiffness of the shoulder with < 0° of external rotation. The mean follow-up was 4.3 years (1.5 to 10). The Constant score and the range of movement of the shoulder were recorded preoperatively and at final follow-up. Preoperatively, radiographs in two planes were performed, as well as CT or arthro-CT scans; radiographs were also performed at final follow-up. Results The mean Constant score improved from 25 points (5 to 47) preoperatively to 57 points (15 to 81) postoperatively. The mean forward elevation of the shoulder increased from 73° (10° to 130°) preoperatively to 117° (15° to 170°) postoperatively. Previous surgery did not influence the outcome. Patients with rotator cuff tears had lower Constant scores than patients without (p = 0.037). Those with preoperative stiffness of the shoulder had lower postoperative external rotation compared with patients without stiffness (p = 0.046). There was no radiographic evidence of loosening. Three complications occurred, leading to revision surgery in two patients. In all, 17 patients rated their result as very good (45%), another 17 as good (45%), two as satisfactory (5%), and two as unsatisfactory (5%). Discussion RSA is an effective form of treatment for patients with type 1 sequelae of a fracture of the proximal humerus associated with rotator cuff deficiency or stiffness of the shoulder, with high rates of satisfaction. Rotator cuff tears and stiffness of the shoulder had an adverse effect on the clinical outcome. Cite this article: Bone Joint J 2018;100-B:318–23.

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Management of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction vs. Marginal Convergence (236)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00344 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0034

Author(s):

Neel Patel ◽

Nyaluma Wagala ◽

Christopher Como ◽

Bryson Lesniak ◽

Albert Lin

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Treatment Options ◽

Reoperation Rate ◽

Rotator Cuff Tears ◽

Treatment Groups ◽

Superior Capsular Reconstruction ◽

The Mean ◽

Reverse Total Shoulder

Objectives: Irreparable rotator cuff tears can be challenging to manage in younger patients who are not well indicated for reverse total shoulder replacement. Treatment options in this patient population include both marginal convergence (MC) and superior capsular reconstruction (SCR). While both treatment options have demonstrated good short term outcomes, they have vastly different associated costs and operative times. Thus, the purpose of this study was to compare range of motion (ROM), patient reported outcomes, and re-operation rates following MC and SCR. We hypothesized that SCR would outperform MC regarding functional and subjective outcomes. Methods: A retrospective review was conducted on 44 patients from two surgeons with irreparable rotator cuff tears that underwent either MC (28 patients, 28 shoulders) or SCR (16 patients, 16 shoulders) from 2014-2019 at a single academic center. Patient inclusion criteria were the following: failed conservative or prior surgical management, no or mild glenohumeral arthritis, Goutallier grade 3 or 4 fatty infiltration of the involved muscles, Hamada grade 1 or 2 rotator cuff arthropathy, intact or repairable subscapularis tear and minimum of 1 year follow-up. Visual Analogue Scale (VAS) for pain, active forward flexion (FF) and external rotation (ER) range of motion, reoperation rate, and rate of conversion to reverse total shoulder arthroplasty were evaluated. For statistical analysis, t-tests were used to determine differences in functional outcomes and VAS, while Chi-Squared tests were used to determine differences in the rate of re-operation and conversion to arthroplasty (*p < 0.05). Results: The mean age at the time of surgery for the MC and SCR groups was 64.4 and 58.5 years, respectively, with an average follow-up of 31.5 months for the MC group and 17.8 months for the SCR group. There were no significant differences in the mean age at the time of surgery, gender, body mass index, pre-operative FF and ER, and pre-operative VAS between the groups. The MC group did not have a significant improvement FF with a mean pre-operative FF of 144.4°(range: 30-170°) and post-operative FF of 150.5°(range: 90-180). The same was true for the SCR group, with a mean pre-operative FF 127.5°(range: 40-170°) and post-operative FF of 146.3°(range: 40-170). There was also no significant improvement in ER post-operatively in either group. Both the MC and SCR group had significant improvements in VAS for pain from an average of 7.3 (range: 1-10) pre-operatively to 2.5 (range: 0-10) post-operative for the MC group (p < 0.01) and from 7.3 (range: 3-10) pre-operatively to 1 (range: 0-4) post-operative for the SCR group (p < 0.01). There were no significant differences in the post-operative FF or ER, change in FF or ER, post-operative VAS, or change in VAS between the two treatment groups. The rate of conversion to arthroplasty was not significantly different between the groups at 3.6% for the MC group and 12.5% for the SCR group. Additionally, the overall reoperation rate was not significantly different between the MR and SCR groups at 10.7% and 12.5%, respectively. Conclusions: There were no significant differences between the MC and SCR treatment groups. While both MC and SCR were effective in improving VAS for pain, neither treatment consistently resulted in significant improvement in ROM. Further studies with long term outcomes are needed to determine if there are certain indications for which one treatment results in better outcomes.

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