Nonarthroplasty options for massive, irreparable rotator cuff tears have improvement in range of motion and patient-reported outcomes at short-term follow-up: a systematic review

Abstract

PurposeTo compare various nonarthroplasty treatment options for massive, irreparable rotator cuff tears, including allograft bridging/augmentation, debridement, partial repair, superior capsule reconstruction (SCR), subacromial balloon spacer, and tendon transfer. MethodsA comprehensive search was conducted through the PubMed, MEDLINE, and EMBASE databases for all articles pertaining to nonarthroplasty treatment options for irreparable rotator cuff tears. Inclusion criteria included manuscripts published between 2009 and 2020 with at least 1 year follow‐up and Level I–IV evidence. Articles were separated into six groups: debridement, arthroscopic and open repair, allograft bridging/augmentation, SCR, subacromial balloon spacer, and tendon transfer. Data points included range of motion (external rotation, abduction, forward flexion, and internal rotation), visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, rate of revision surgery, and rate of conversion to arthroplasty. ResultsA total of 83 studies and 3363 patients were included. All treatment options had statistically significant improvements in postoperative range of motion and patient‐reported outcomes. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. The SCR subgroup had the greatest improvement in ASES scores postoperatively. The overall revision rate was 7.2% among all surgical options, with the allograft bridging/augmentation group having the lowest rate of revision at 0–8.3%. The overall rate of conversion to arthroplasty was 7.2%, with debridement having the greatest rate of conversion at 15.4%. ConclusionAll six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient‐reported outcomes at 1 year follow‐up or more, with low rates of revision and conversion to arthroplasty. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. However, these conclusions should be interpreted with caution due to the heterogeneous nature of the data, lack of prospective randomized control trials, and short‐term follow‐up. The findings of this study highlight the complexity of irreparable, massive rotator cuff tears, and the need for an individualized approach when treating these patients. Level of evidenceLevel IV.

Arthroscopic Rotator Cuff Repair With Superior Capsule Reconstruction for Irreparable Supraspinatus Tears

“…Irreparable rotator cuff tears represent approximately 12% of all tears, 4 and multiple surgical techniques for addressing these have been described. 3 Superior capsule reconstruction has demonstrated a reduced superior translation of the humeral head, 1,8,9 decrease of acromion contact pressures, 7 and improved patient range of motion and functional outcomes. 2,5,6 This patient is a 51-year-old right-hand-dominant man who sustained a traumatic rotator cuff tear 10 months prior.…”

A modified Patte classification system for rotator cuff tendon retraction to predict reparability and tendon healing in arthroscopic rotator cuff repair

“…For evaluating tendon retraction, the classification system proposed by Patte (Figure 1a) has been widely used [33]. In our experience, rotator cuff tears with stage 3 retraction (proximal stump at the glenoid level) are not frequently treated with ARCR but with other surgical procedures such as tendon transfer [4,27], superior capsular reconstruction (SCR) [13,29] or reversed shoulder arthroplasty (RSA) [14,35] because stage 3 tears are indicated as a significant predictive factor for irreparability and healing failure. Consequently, most tears treated with ARCR are classified as stage 2 (proximal stump at the level of the humeral head).…”

In Vivo Graft Elongation After Arthroscopic Dermal Superior Capsular Reconstruction

“…28 Some of the current nonarthroplasty treatment options for irreparable rotator cuff tears include debridement, 12 partial repair, 2,11 and tendon transfer. 5 There is a lack of evidence regarding the superiority of any of these nonarthroplasty options, 7,13,21 and they may not be an option for some cases. 20 One emerging option for irreparable rotator cuff tears is superior capsular reconstruction (SCR).…”