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

Abstract

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.

Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears Results in Significant Improvements in Patient Reported Outcomes and Range of Motion: A Systematic Review

“…Mean change of postoperative AHD ranged from −0.86 to 3.2 mm in 9 studies. 31 , 32 , 34 , 36 , 37 , 38 , 39 , 42 , 44 The main outcome measures, from preoperation to final follow-up, are shown in Table 4 .…”

“…These complications included graft failure, infection, severe shoulder stiffness, suture anchor pullout, donor site problem, progressed arthritis, subscapularis tendon retear, loss of function, and severe synovitis. Structural graft failure such as graft tears were diagnosed by postoperative magnetic resonance imaging (MRI) scans in 14 studies, 18 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 of which 10 studies, 18 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 44 described the locations of graft failures. The reoperation was showed in 11 studies, 18 , 33 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 43 , 44 and the reoperation rate ranged from 0 to 12.5%.…”

“…There were clinically significant improvements in both VAS scores and ASES scores by meeting the MCID threshold (Fig 2). 16 The mean improvements in CS scores ranged from 14.64 to 50.79 points in 4 studies 18,32,40,44 (P < .05 for all). One study by Mihata et al 35 reported the Japanese Orthopedic Association score (JOA) with a mean improvement of 39.42 points (P < .05).…”

Joint-preserving surgical treatment options for irreparable posterosuperior rotator cuff tear

“…No clinical outcome differences were seen between patients after APR versus arthroscopically assisted latissimus dorsi tendon transfer (LDT) during a short-term follow-up period [1]. A randomized trial demonstrated no significant difference in clinical treatment outcomes 2 years after APR vs. SCR in 41 patients [19].…”

Understanding shoulder pseudoparalysis. Part II: Treatment

“…A prospective study by Greiner et al conducted in 2021 compared patients undergoing partial infraspinatus repair of the residual cuff with those undergoing SCR for massive irreparable rotator cuff tears ( 23 ). There was no significant difference in CMS score between the partial repair and SCR groups, concluding that both are viable options.…”