Five-year Follow-up of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

Abstract

Objectives: For irreparable rotator cuff tears, we developed a new surgical treatment—arthroscopic superior capsule reconstruction (SCR)—to restore superior shoulder stability, muscle balance, and shoulder function. The objective of this study was to assess (1) changes in functional outcome; (2) changes in graft thickness; (3) rates of graft tear; and (4) rates of glenohumeral osteoarthritis during a 5-year follow-up period. Methods: From 2007 to 2013, arthroscopic SCR using autograft of fascia lata was performed on 37 shoulders with irreparable rotator cuff tears. Seven patients were lost to follow-up. Consequently, 30 shoulders (mean age, 68.0 years) were enrolled in the study. Shoulder range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, acromiohumeral distance (AHD), Hamada grade, and Goutallier grade were compared among before surgery, 1 year after SCR, and 5 years after SCR. Graft thickness, which was measured in MRI, was compared among 3 months, 1 year, and 5 years after SCR. One-way analysis of variance followed by Fisher’s LSD post-hoc test was performed for statistical analysis. In addition, rates of return to sport or work were investigated in those patients who had been employed (12 patients: 5 carpenters, 5 farmers, and 2 construction workers) or played sports (8 patients: 2 table tennis, 1 golf, 1 martial arts, 1 yoga, 1 badminton, 1 mountain-climbing, and 1 ground golf) before injury. Results: Both ASES and JOA scores after arthroscopic SCR improved significantly at both 1 year ( P < 0.001) and 5 years after SCR ( P < 0.001). ASES score at 5 years after SCR was significantly better than that at 1 year after SCR ( P = 0.02). Postoperative ASES scores at both 1 year and 5 years after SCR were better in healed patients (27 patients) than in unhealed patients suffering from graft tear (3 patients). Active elevation was significantly improved at both 1 year and 5 years after SCR ( P < 0.001). At five years after SCR, 11 patients were still working and one patient, who had returned to part-time work at 1 year, had retired. All 8 patients were still playing sport before their injuries at 5 years after SCR. AHD was increased significantly at both 1 and 5 years after SCR ( P < 0.001). There was no significant difference in AHD between 1 and 5 years after SCR ( P = 0.16). In the 27 patients in whom the graft remained intact, graft thickness did not differ significantly among 3 months, 1 year, and 5 years after SCR ( P = 0.67). Hamada grade was significantly improved at both 1 and 5 years after SCR (preoperative: 2.3 ± 0.8; 1 year: 1.3 ± 0.7; 5 years: 1.3 ± 0.7, P < 0.001). All patients who had graft healing had no progression of glenohumeral osteoarthritis during the 5-year follow-up period. Two of the 3 patients with graft tear were suffering severe glenohumeral osteoarthritis (with narrowing of the glenohumeral joint space) at 5 years after SCR. The Goutallier grade did not change significantly after SCR in any patients. Conclusion: In a 5-year follow-up study, arthroscopic SCR restored shoulder function and resulted in high rates of return to recreational sport and work. Shoulder function and ROM were likely to get better with time. Graft tear exacerbated the clinical outcome after SCR and caused glenohumeral osteoarthritis in 2 of 3 patients by 5 years after SCR. Graft thickness and postoperative AHD did not change significantly between 1 and 5 years of follow-up, suggesting that we can expect excellent functional outcomes with long-term follow-up. [Table: see text]

Failure Rate After Superior Capsular Reconstruction With Achilles Tendon–Bone Allograft for Irreparable Rotator Cuff Tears

“…The literature has shown that graft integrity can positively affect functional outcomes. 7,35 –39 To decrease the graft failure rate, a thick graft can enhance stiffness. 36 However, despite the robust Achilles tendon–bone allograft used, the current study shows a high graft failure rate, which perhaps corresponds to unsatisfactory clinical outcomes.…”

Surgical Technique for Superior Capsule Reconstruction With 6-mm Acellular Dermal Allograft and Knotless Glenoid Anchors

“…SCR is a method by which to recreate a humeral head depressor, and success has been demonstrated with both autograft and allograft tissues. 4,7 Furthermore, the thickness of ACD has been shown to influence the ability of the reconstructed superior capsule to perform its role as a humeral head depressor. Recently a 6-mm thick graft, double the normal thickness of a traditional 3-mm acellular dermal allograft, has been shown to be noninferior to recreating native shoulder biomechanics.…”

“…2,3 Superior capsular reconstruction (SCR) is a viable, reproducible method by which to create a humeral head depressor in the setting of irreparable rotator cuff tears. [4][5][6][7] Many techniques exist for creating this subacromial augment and include the use of both autograft and allograft tissues. Mihata et al 3 have demonstrated successful restoration of superior stability using fascia lata with continued clinical success at 5-year follow-up.…”

“…Mihata et al 3 have demonstrated successful restoration of superior stability using fascia lata with continued clinical success at 5-year follow-up. 7 More recently, human acellular dermal allograft (ACD) has been used in place of fascia lata autograft to decrease donor-site morbidity as well as operative times. 8 When using a 6-mm graft, this ACD been shown to be noninferior to fascia lata in restoring biomechanics of a native shoulder joint.…”

Superior Capsule Reconstruction With a 3 mm–Thick Dermal Allograft Partially Restores Glenohumeral Stability in Massive Posterosuperior Rotator Cuff Deficiency: A Dynamic Robotic Shoulder Model

“…Improved clinical outcomes, marked by high rate of return to work and sports, have been recorded in short-and midterm trials. [18][19][20][21] Furthermore, several biomechanical studies have shown that SCR prevents superior migration of the humeral head in the presence of isolated supraspinatus tears. 8,17,22,25,26 By maintaining the humeral head in its native position, SCR allows the remaining rotator cuff muscle groups and the deltoid muscle to compensate for the lack of the supraspinatus during early abduction and forward elevation, improving overall joint function.…”