Arthroscopic Superior Capsular Reconstruction for the Treatment of Massive Irreparable Rotator Cuff Tears in the Active Patient: 1-2 year Results

Abstract

To report our results in the first 58 shoulders in 57 patients undergoing arthroscopic superior capsular reconstruction for the treatment of the younger active patient with irreparable rotator cuff tears and rotator cuff arthropathy. 57 consecutive patients presented with massive irreparable rotator cuff tear with retraction and atrophy (Goutallier grade 4). One patient has undergone bilateral arthroscopic superior capsular reconstruction. All had failed previous treatments including surgical and non- surgical modalities. These patients were too young and active (ages 42-67) for treatment with reverse total shoulder arthroplasty. All patients had unacceptable pain and weakness. The tears involved the supraspinatus or both supraspinatus and infraspinatus tendons. All patients were treated with arthroscopic superior capsular reconstruction with an acellular dermal allograft. Evaluation utilizing an internet based outcome tracking system, radiographic analysis and functional assessment to assess range of motion and dynamometric strength data utilized to track outcomes. At minimum of one year follow up, 56/57 shoulders are satisfied. One shoulder went on to revision to reverse total shoulder arthroplasty. Outcome data analysis demonstrated significantly improved scores in visual analog scores (3.6 to 1.3), Simple shoulder test (39 to 64), SANE Scores (31 to 65), ASES Function scores (14 to 21), and ASES Index scores (45 to 64) at minimal one year follow up. Active range of motion measurements in forward flexion and abduction as well as dynamometric strength measures have shown significant improvement as well. Radiographic analysis demonstrated significant improvement in acromiohumeral distance that was maintained over the postoperative period (1 to 2 years). Arthroscopic superior capsular reconstruction with acellular dermal allograft has been a successful procedure in decreasing pain and improving function during this early postoperative period. As this procedure “burns no bridges”, it is an attractive alternative to reverse total shoulder arthroplasty in the young active patient population.