Superior capsular reconstruction: 2-year follow-up results

INTRODUCTION: A prerequisite for a satisfying functional result in the treatment of an irreparable rotator cuff rupture is a significant reduction of shoulder pain and better range of motion with an increase in anatomic glenohumeral joint stability. PURPOSE: Prospective study to examine the outcome after superior capsular reconstruction using a porcine extracellular matrix dermal graft. A special emphasis was primarily on the functional outcome, secondarily on radiographic shoulder changes, that superior capsular reconstruction might yield. METHODS: Clinical results were evaluated using the Constant score and Western Ontario Rotator Cuff (WORC) index over a 2-year period. All patients had magnetic resonance imaging (MRI) of the injured shoulder after 1 year. Graft integration and durability were qualitatively estimated as well as any graft deterioration or resorption. RESULTS: Thirteen patients with 13 superior capsular reconstructions were included over a 3-year period. Mean age was 61 years (range 50-70) at the time of surgery. At final follow-up (mean 24 months, range 23-32), the mean Constant score had improved from an average of 24.9-55.7 points. The mean WORC index had increased from a percentage average of 32.3%-61.9%. Eleven of 13 grafts were intact on follow-up MRI. CONCLUSION: Our hypothesis was that successful implantation of a dermal xenograft would correlate with both better functional outcome and stabilized glenohumeral radiographic features. We saw a group of patients with variable but significant increases in functional results and in general with limited pain and with an intact xenograft on an MRI scan. We did not find a positive correlation between functional outcome scores and graft durability nor with single cuff tendon defects vs. larger rotator cuff defects. This study suggests that a superior capsular reconstruction can yield results that are comparable or superior to other known salvage treatment options in patients with large to massive rotator cuff defects without significant cuff tear arthropathy. The hypothesis that superior capsular reconstruction can be a relevant treatment method for irreparable rotator cuff tears could not be refuted despite a fairly low patient inclusion number. With these results, selected patients can be considered for a different treatment than reverse shoulder arthroplasty, débridement, or tendon transfer.