Alan M. Hirahara, MD, FRCSC
Orthopaedic SurgeonSpecialist in Sports Medicine

Superior Capsular Reconstruction using Dermal Allograft is a Safe and Effective Treatment for Massive Irreparable Rotator Cuff Tears: 2-year Clinical Outcomes

Pashuck TD, Hirahara AM, Cook JL, Cook CR, Andersen WJ, Smith MJ
Arthroscopy
DOI: https://doi.org/10.1016/j.arthro.2020.10.014
PMID: 33080333

October 17th 2020

Purpose: To evaluate functional, symptomatic, and diagnostic imaging outcomes after arthroscopic superior capsular reconstruction (SCR) using dermal allograft in patients with massive irreparable rotator cuff tears.
Methods: From 2015-2017, this multicenter study retrospectively evaluated patients undergoing arthroscopic SCR for treatment of symptomatic massive rotator cuff tears. Study criteria included the presence of a massive irreparable rotator cuff tear with retraction to the glenoid without diffuse bipolar cartilage loss, Grade 4 or 5 Hamada classification, and subscapularis pathology that could not be addressed. Outcome measures included visual analog pain scale (VAS) score, the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and active forward elevation (FE) through 2 years postoperatively. Imaging analyses included radiographs, ultrasound and magnetic resonance imaging at 6-months and 1-year.
Results: Fourteen patients met all study criteria including required follow-up. There were statistically significant improvements in VAS pain (3.3 to 0.6, P =0.019), ASES (55.0 to 86.5, P =0.034), SANE (33.1 to 71.5, P =0.028), and active FE (128 to 172, P =0.007) through 2 years after surgery. Thirteen grafts (93%) had ultrasonographic evidence for vascularity by 1 year postoperatively. There were two graft complications (14%) with one (7%) requiring revision to reverse total shoulder arthroplasty.

Conclusions/Clinical Relevance: Arthroscopic superior capsular reconstruction using dermal allograft can be a safe and effective treatment option for patients with massive irreparable rotator cuff tears based on functional, symptomatic, and diagnostic imaging outcomes. Neutral abduction of the arm at the time of implantation resulted in positive clinical outcomes and may decrease graft failure rate.