Salvaging the 'irreparable' tear: Superior Capsular Reconstruction augmented with partial cuff repair

Area of Science:

• Orthopedic Surgery
• Shoulder Reconstruction
• Musculoskeletal Research

Background:

• Massive rotator cuff tears (MRCTs) often lead to irreparable rotator cuff tears (RCTs) with poor functional outcomes due to tendon retraction, fatty infiltration, and muscle atrophy.
• Prompt treatment is crucial to prevent irreversible damage and functional deficits.

Purpose of the Study:

• To describe a surgical technique for superior capsular reconstruction (SCR) augmented with partial cuff repair.
• To report short-term outcomes of this augmented SCR technique for MRCTs.

Main Methods:

• A case series of seven consecutive patients with MRCTs undergoing augmented SCR between January 2019 and December 2019.
• Review of pre-operative data, intra-operative findings, and post-operative outcomes including pain, range of motion, and validated shoulder scores.

Main Results:

• All seven patients had irreparable tears of at least two tendons, with significant muscle wasting.
• At 12 months post-surgery, significant improvements were observed in Constant (12.1 points), UCLA (9.4 points), and Oxford Shoulder scores (17 points).
• Mean improvement in active forward flexion was 40 degrees, and mean pain reduction on the Numerical Pain Rating Scale was 5.1 points.

Conclusions:

• Superior capsular reconstruction augmented with partial cuff repair demonstrates good short-term functional outcomes for patients with massive rotator cuff tears.
• This technique shows particular promise for challenging revision rotator cuff repairs.