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Superior capsule reconstruction improved outcomes in patients with massive rotator cuff tears
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NEW YORK — Patients with massive rotator cuff tears who underwent superior capsule reconstruction experienced significant improvements in patient-reported outcome scores, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.
Raffy Mirzayan, MD, and colleagues recorded Hamada grade, Goutallier stage, surgical findings and patient-reported outcome scores for 53 patients with massive rotator cuff tears who underwent superior capsule reconstruction.
“An MRI was obtained in 80% of patients at a mean of 14 months, and the MRI revealed that only 38% of grafts were intact,” Mirzayan said in his presentation here.
Of the patients who had a tear in their graft, Mirzayan noted half of the patients had glenoid tears, 19% had mid-substance tears, 23% had tuberosity tears and one patient had complete graft absence.
“These patterns could be divided into three groups,” Mirzayan said. “Number one, an intact graft; number two, a tear leaving the tuberosity covered; and number three, a tear leaving the tuberosity bare.”
Mirzayan noted patients with an intact graft and patients with a tear leaving the tuberosity covered had significant improvements in ASES and Oxford scores. However, he added patients with graft tears leaving the tuberosity bare experienced no improvements. All three groups had significant improvements in VAS, according to Mirzayan. Although patients in the intact graft and tuberosity-covered groups had no differences in postoperative single assessment numeric evaluation (SANE) scores, Mirzayan said patients in the tuberosity-bare group had significantly worse SANE scores.
“There was no association between Goutallier stage with postoperative ASES scores, no association between Hamada grade and postoperative ASES scores, and there were no differences in postop ASES and Oxford scores and the improvement in these scores between male and female patients,” Mirzayan said. “There was also no difference in the postop ASES scores in those patients who had prior surgery to those who did not.” – by Casey Tingle
Reference:
Mirzayan R, et al. Paper 1. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.
Disclosure: Mirzayan reports he receives stock or stock options from AlignMed and is a paid presenter or speaker for a receives research support from Arthrex Inc.
Perspective
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Patrick J. Denard, MD
This paper by Raffy Mirzayan, MD, and colleagues out of Kaiser in California looked at superior capsule reconstruction done by multiple surgeons. Fifty-three patients were reviewed with overall improvement in functional outcome. There are two primary interesting findings here. First, is that not all the grafts healed, which is not surprising. Second, and most interesting, was that patients who did heal had improved outcomes compared to the patients who did not heal. So, what that tells us is that the procedure works when the graft heals. Therefore, we need to focus on obtaining healing by optimizing the biomechanics of the procedure, our surgical technique and postoperative rehab.
Southern Oregon Orthopedics
Medford, Oregon
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