Superior Capsular Reconstruction for Massive Rotator Cuff Tear Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic Review

Abstract

To determine if arthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears results in statistically significant and clinically significant improvement in patient-reported outcomes and shoulder range of motion with low graft failure, complication, and reoperation rates. A systematic review was registered with PROSPERO and performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane databases were searched. Studies investigating superior capsular reconstruction in adults were included. Animal, cadaveric, and review studies, letters to the editor, and technique papers were excluded. Study methodological quality was analyzed using the Modified Coleman Methodology Score. Shoulder motion and patient-reported outcome scores were analyzed. Statistical significance was defined by P < .05, and clinical significance was defined by the minimal clinically important difference. Six articles (286 subjects, 292 shoulders, 67.7% males, mean age 63.4 ± 4.1years, mean follow-up 25.7 ± 14.5months) were analyzed. The methodological quality was fair (59.7 ± 13.8). Five studies reported significant improvement in the American Shoulder and Elbow Surgeons (ASES) score (mean range: 30-55, P < .001 for all). Visual analog scale (VAS) scores significantly improved in 3 studies (mean range: 2.5-5.9, P < .001 for 2 and P= .005 for 1). Shoulder forward flexion (mean range: 28°-56°, P < .001 for 2 and P= .04 for 1) significantly increased in 3 studies. One hundred percent of subjects from 2 studies had clinically significant improvement in ASES and VAS scores and shoulder forward flexion. Thirty-six subjects (14.2% of 254) had graft failure on magnetic resonance imaging (MRI). Eleven subjects (3.8%) had complications, and 34 (11.7%) underwent reoperation. Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears results in statistically significant and clinically significant improvement in patient-reported outcomes and shoulder range of motion with low graft failure, complication, and reoperation rates at short-term follow-up in fair-quality studies. Level IV, systematic review of Level III and IV studies.