Superior capsular reconstruction may be effective for irreparable rotator cuff tears
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Superior capsular reconstruction using a dermal allograft had positive outcome scores and a low revision rate in patients with irreparable rotator cuff tears, according to results.
Daniel Hurwit, MD, and colleagues from Hospital for Special Surgery analyzed 72 patients (mean age of 61.6 years) who underwent superior capsular reconstruction (SCR) from 2012 to 2017, 41.7% of which had a history of failed rotator cuff repair. According to the abstract, patient-reported outcomes were measured by single assessment numeric evaluation (SANE), American Shoulder and Elbow Surgeons and University of California, Los Angeles (UCLA) scores.
“All patients with available pre- and postoperative active [range of motion] demonstrated significant improvements in forward elevation (81.5° to 155.9°), abduction (46.4° to 145.9°) and external rotation (28.7° to 66.6°),” Hurwit and colleagues wrote in the abstract. “At a mean follow-up of 11.1 ± 8.4 months (range 3 [to] 33 months), postoperative patient-reported outcome scores averaged 79.7 for SANE, 78.1 for ASES and 29.7 for UCLA scores,” they added.
Five of the 72 patients required revision surgery. Four patients underwent reverse shoulder arthroplasties and one underwent revision SCR, according to the abstract.
“At short- to intermediate-term follow-up, SCR using a dermal allograft led to improvements in active ROM including forward elevation, abduction, external rotation and internal rotation, as well as favorable patient-reported outcome scores in patients with symptomatic irreparable rotator cuff tears, with a revision surgery rate of 6.9%,” Hurwit and colleagues concluded.
Perspective
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Julie Y. Bishop, MD
The use of SCR to address the irreparable rotator cuff tear has only been around for a short time in the U.S. and hence there has been a paucity of U.S. driven data to support the use of the procedure. Therefore, the authors of this paper should be commended for putting this paper forward. Only through multiple outcomes-based research papers will we be able to determine if this procedure ultimately has merit, and most important if it has longevity. Clearly this paper has shown that with a mean follow-up of 11.1 months, there were significant improvements in range of motion and patient reported outcomes surveys. As we move the conversation about this procedure forward, long-term follow-up is a necessity to truly tell how effective SCR may be. Further, our research should focus on helping surgeons determine the best candidates, and this goes in tandem with determining the long-term outcomes. We must work toward an understanding of the Hamada level that is acceptable to proceed with SCR, the patient age and activity level, how outcomes are influenced by the status of the subscapularis, and how successful is SCR in treating the truly pseudoparalytic patient. Clearly, SCR has shown great early promise, and more research is needed to drill down into these other areas.
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Hurwit D, et al. Poster 209. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
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