Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.

1. 1. Background
2. Aims
4. Results
5. Conclusion
References
3. Methods
Early outcomes of Arthroscopic Superior Capsular Reconstruction
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Wrightington Hospital, United Kingdom
Recent evidence continues to confirm the effectiveness of
Arthroscopic Superior Capsular Reconstruction (SCR) in relieving
pain and improving function in a cuff deficient shoulder (1,2,3). Being
a relatively new procedure, identifying the factors affecting outcome
will help us to define the specific patients in whom this procedure
can be offered for successful outcome.
This study is aimed at expanding our limited knowledge regarding
the learning curve of arthroscopic Superior Capsular reconstruction
of shoulder and the pre-operative factors that can predict the
outcome of the procedure.
• This was a prospective surveillance study.
• Surgery was performed for irreparable rotator cuff tears (wihtout
severe arthritic changes) and an Allograft was utilised for
reconstruction.
• The first 49 consecutive cases performed by 3 surgeons over 3
years (including their learning curve) were analysed.
• Outcomes assessed were re-operation rates, patient satisfaction
and complications.
• The study group was analysed to identify the factors predicting
outcomes.
• The average age was 56 (±9) years and the mean follow-up
period was 19 months (3-37 months).
• The re-operation rate was 12.2% with all the 6 patients
subsequently undergoing a reverse shoulder arthroplasty.
• 40 (82%) patients were satisfied with the outcome of the
procedure, with 35 (72%) showing complete pain relief, 5 (10%)
having dull aches and clicks and the remaining 9 (18%) were
unsatisfied due to pain.
• Patients with multiple previous surgeries of same shoulder
(p=0.02) and teres minor atrophy/tear (p=0.03) were associated
with poor outcomes.
• Patients with degenerative tears, symptoms of longer duration
(>24 months) and subscapularis tear/atrophy showed a trend
towards inferior outcomes (but not statistically significant).
Cautious optimism following SCR may be offered to this
challenging subset of patients with symptomatic irreparable rotator
cuff tears. It is likely that the relatively low re-operation rates can be
further improved by considering the negative prognostic factors in
defining indications for surgery. Further studies with longer term
followup are recommended.
1. Mihata T, Lee TQ, Fukunishi K, et al. Return to Sports and Physical Work After Arthroscopic Superior Capsule Reconstruction Among Patients With Irreparable Rotator Cuff Tears. Am J Sports Med.
2018;46(5):1077-1083. doi:10.1177/0363546517753387
2. Denard PJ, Brady PC, Adams CR, Tokish JM, Burkhart SS. Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft. Arthroscopy. 2018;34(1):93-99.
doi:10.1016/j.arthro.2017.08.265
3. Pennington WT, Bartz BA, Pauli JM, Walker CE, Schmidt W. Arthroscopic Superior Capsular Reconstruction With Acellular Dermal Allograft for the Treatment of Massive Irreparable Rotator Cuff Tears:
Short-Term Clinical Outcomes and the Radiographic Parameter of Superior Capsular Distance. Arthroscopy. 2018;34(6):1764-1773. doi:10.1016/j.arthro.2018.01.009
Complication Number of patients
Infection 0
Re-operation 6
Graft rupture 3
Graft
detachment
8
Anchor pullout 0
Factors Satisfied Unsatisfied P-value Odds Ratio
Age < 60 26 6 (18.7%)
0.9243 -
Age >60 14 3 (17.6%)
Type of surgery
Primary 14 2 (12.5%)
0.6981 1.7
Revision 26 7 (21.2%)
No. of previous surgeries
1 previous surgery 23 3 (11.5%)
0.0229 5
> 1 Previous surgery 3 4 (57.1%)
Type of tear
Traumatic 30 5 (14.3%)
0.2542 2
Degenerative 10 4 (28.6%)
Duration of tear
<24mon 21 3 (12.5%)
0.2865 2
>24 mon 17 6 (26%)
Teres Minor
Normal 38 6 (13.6%)
0.0371 4.4
Atrophic 2 3 (60%)
Subscapularis
Normal 29 5 (14.7%)
0.4272 1.8
Tear/Atrophy 11 4 (26.6%)
Increased risk, but not statistically significant
Degenerative tears
>24 months duration
Subscapularis tear
Factors predicting poor outcome
Table 1:Complications seen
Table 2: Analysis of Outcome
Fig 2: Satisfaction Rate
Fig 2: Type of SurgeryFig 1: Age Distribution
Statistically significant
>1 previous surgery
Teres minor tear/atrophy