Abstract
Abstract Background Massive irreparable rotator cuff tears (RCT) may cause severe functional impairment and pain as a result of loss of superior humeral stability. Reconstruction of the superior capsule (SCR) has been reported to restore glenohumeral stability and function. Objective The purpose of this study was to investigate short-term functional and radiological outcome after arthroscopic SCR with a human dermal allograft for irreparable RCT. Methods In total, 21 patients (mean age 65.9 years, 50–77), who underwent arthroscopic SCR were prospectively enrolled in the present study. Magnetic resonance images (MRI) were obtained before and 12 months after surgery to evaluate graft survival. Functional and subjective outcome including the Constant score (CS), the American Shoulder and Elbow Surgeons score (ASES), and the Simple Shoulder Test (SST) was evaluated preoperatively as well as 3–6 and 12 months postoperatively and was compared between patients with and without preoperative pseudoparalysis. Complications were recorded. Results The MRI evaluation revealed intact grafts in 71.4% of patients 1 year postoperatively; these patients showed significant improvements from baseline to follow-up time points regarding the total CS and its subgroups pain, activity of living, range of motion, strength, ASES, and SST (p < 0.01). Pseudoparalysis was present in 57.1% of cases preoperatively, but was reversed in 100% of cases with intact graft at the 1‑year follow-up. The outcome was similar between groups at final follow-up. Complications occurred in 29% (one infection, five graft failures) of patients and were indications for treatment with reverse shoulder arthroplasty. Conclusion Arthroscopic SCR with a human dermal allograft in patients with irreparable RCT restored shoulder function and relieved pain in patients without and with preoperative pseudoparalysis.
Highlights
Irreparable posterosuperior rotator cuff ruptures in the young patient remain a challenging clinical entity
In a biomechanical laboratory setting, it was shown that a significant reduction in superior humeral translation and an increase in subacromial distance could be achieved with reconstruction of the superior glenohumeral joint capsule, while these effects were enhanced by sideto-side suturing between the infraspinatus and the posterior margin of the graft [20, 21]
These promising in vitro results were confirmed in a clinical study showing relatively quick pain reduction, followed by a significant increase in range of motion [19]
Summary
Irreparable posterosuperior rotator cuff ruptures in the young patient remain a challenging clinical entity. In a biomechanical laboratory setting, it was shown that a significant reduction in superior humeral translation and an increase in subacromial distance could be achieved with reconstruction of the superior glenohumeral joint capsule, while these effects were enhanced by sideto-side suturing between the infraspinatus and the posterior margin of the graft [20, 21]. These promising in vitro results were confirmed in a clinical study showing relatively quick pain reduction, followed by a significant increase in range of motion [19]. Arthroscopic SCR with a human dermal allograft in patients with irreparable RCT restored shoulder function and relieved pain in patients without and with preoperative pseudoparalysis
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