Outcome Comparison of Graft Bridging and Superior Capsule Reconstruction for Large to Massive Rotator Cuff Tears: A Systematic Review

Abstract

Background: Graft bridging (GB) and superior capsule reconstruction (SCR) were developed to treat large to massive rotator cuff tears (RCTs); however, the outcome differences between GB and SCR remain unclear. Purpose: To systematically review and compare the outcomes of GB and SCR for large to massive RCT. Study Design: Systematic review. Methods: A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of GB or SCR were included according to the inclusion and exclusion criteria. The primary outcome was Constant-Murley score at the final follow-up. Secondary outcomes included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, active shoulder range of motion, and graft healing rate. Complication rate was the safety outcome measure. Outcomes were summarized into group SCR and group GB, and the results were compared statistically ( P < .05). Results: A total of 23 studies were included in this review: 238 repairs from the 5 studies in group SCR and 593 repairs from the 18 studies in group GB. For group SCR and group GB, the mean age was 61.6 and 63.3 years, and the mean follow-up was 18.0 and 40.1 months, respectively. Overall, both procedures demonstrated improvement of clinical outcomes. When compared with group SCR, group GB had significantly higher mean differences of the Constant-Murley score (41.9 vs 19.8), American Shoulder and Elbow Surgeons score (39.3 vs 33.8), visual analog scale score for pain (4.4 vs 3.4), and active external rotation at side (15.3 vs 9.3). No statistically significant difference was detected in the mean difference of active forward flexion, internal rotation, abduction, and graft healing rate between the groups. The complication rates were 0.84% (2 of 238) in group SCR and 0.67% (4 of 593) in group GB. Conclusion: In general, GB showed significantly better clinical and functional outcomes postoperatively than SCR, with a similar complication rate. The available fair-quality evidence suggested that GB might be a better choice for large to massive RCT. More high-quality randomized controlled studies are required to further evaluate the relative benefits of the 2 procedures.

Clinical Outcomes of Interposition Graft Versus Superior Capsular Reconstruction in Patients With Irreparable Rotator Cuff Tears: A Systematic Review and Meta-analysis

“…The IG group showed significantly lower pain VAS, higher ASES score, and better active FF, ER at side, and IR at final follow-up (all P < .001). On comparing the mean differences 30 between pre- and postoperative functional outcome scores and active ROM, we found the IG group showed significantly improved pain VAS score, Constant score, and active FF and IR (all P < .001). Although there was no difference in the final Constant score between groups, the mean difference was significantly higher in the IG group, indicating greater improvement in Constant scores postoperatively compared with the SCR group.…”

“…Two recent systematic reviews 30 , 55 have evaluated IG and SCR for massive irreparable RCTs. Wall et al 55 reviewed 16 articles published from 2014 to 2017 and documented the surgical techniques and the results of several biomechanical and animal studies.…”

“…They concluded that, as no known literature comparing the 2 procedures existed, it was difficult to definitively assess the outcomes of IG and SCR. 55 More recently, Lin et al 30 reviewed 23 articles published from 2006 to 2019 and concluded that the IG group showed significantly better clinical and functional outcomes postoperatively than the SCR group. We tried to compare the effectiveness of IG and SCR more thoroughly, including more recent studies and using meta-analysis.…”

“…Most studies have evaluated the technique and outcomes of IG or SCR separately, without a control group or a randomized design. There have been only 2 systematic reviews comparing IG and SCR, 30 , 55 and they lacked meta-analyses of the clinical outcomes, graft retear rates, and complication rates.…”

Irreparable Large to Massive Rotator Cuff Tears With Low-Grade Fatty Degeneration of the Infraspinatus Tendon: Minimum 7-Year Follow-up of Fascia Autograft Patch Procedure and Partial Repair

“…38 In the present study, we found clinical features (Tables 3 and 4, Appendix A2) in terms of clinical and structural outcomes in shoulders with low-and high-grade massive RCTs after the patch procedure. 38 Considering our results and the results of previous studies, 18,32,38 we believe that grading of massive RCTs based on the degree of fatty degeneration of the ISP can be useful for determining the appropriate treatment strategy among multiple treatment options for irreparable massive RCTs. 9 This study has 2 major strengths.…”