ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper

 

Management Of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction Vs. Marginal Convergence

Neel K. Patel, MD, Pittsburgh, PA UNITED STATES
Nyaluma N. Wagala, MD, Pittsburgh, PA UNITED STATES
Christopher John Como, BSE, Pittsburgh, PA UNITED STATES
Bryson P. Lesniak, MD, Pittsburgh, PA UNITED STATES
Albert Lin, MD, Pittsburgh, PA UNITED STATES

University of Pittsburgh Medical Center, Pittsburgh, PA, UNITED STATES

FDA Status Not Applicable

Summary

Based on the findings of this study, the clinical outcomes following MC and SCR may be equivalent despite their varying cost and operative time. However, further studies with long term outcomes are needed to determine if there are certain indications for which one treatment results in better outcomes.

Abstract

Introduction

Irreparable rotator cuff tears can be challenging to manage in younger patients with minimal glenohumeral arthritis who are not well indicated for reverse total shoulder replacement. Treatment options in this patient population are usually marginal convergence (MC) and superior capsular reconstruction (SCR). Both of these treatment options have demonstrated good short term outcomes but have vastly different associated costs and operative times. Thus, the purpose of this study was to compare range of motion (ROM), patient reported outcomes, and re-operation rates following MC and SCR. We hypothesized that SCR would outperform MC regarding functional and subjective outcomes as well as re-operation rates.

Methods

Forty-four patients with irreparable rotator cuff tears that underwent either MC (28 patients, 28 shoulders) or SCR (16 patients, 16 shoulders) performed by 2 surgeons from 2014-2019 at a single academic center were retrospectively reviewed. All patients included in the study had failed conservative or prior surgical management, and demonstrated no or mild glenohumeral arthritis, Hamada grade 1 or 2 rotator cuff arthropathy, Goutallier grade 3 or 4 fatty infiltration of the involved muscles, and had an intact subscapularis or repairable subscapularis tear. All patients had a minimum of 1 year follow-up. Active forward flexion (FF) and external rotation (ER) range of motion, Visual Analogue Scale (VAS) for pain, reoperation rate, and rate of conversion to reverse total shoulder arthroplasty were evaluated. For statistical analysis, t-tests and Chi-Squared tests were used to determine differences within and between groups (*p < 0.05).

Results

Average follow-up was 31.5 months for the MC group and 17.8 months for the SCR group. There were no significant differences in baseline characteristics of the patients in either group with regard to the mean age at the time of surgery, gender, body mass index, pre-operative FF and ER, and pre-operative VAS. There was no significant improvement in post-operative FF or ER in either group. Both the MC and SCR group had significant improvements in VAS for pain from an average of 7.3 pre-operatively to 2.5 post-operative for the MC group (p < 0.01) and from 7.3 pre-operatively to 1 post-operatively for the SCR group (p < 0.01). There were no significant differences in the post-operative FF or ER, change in FF or ER, post-operative VAS, or change in VAS between the two treatment groups. The overall rate of reoperation and rate of conversion to arthroplasty was not significantly different between the MR and SCR groups.

Discussion

Both MC and SCR were effective in improving VAS for pain, but did not consistently result in significant improvement in ROM. This finding is contrary to previous studies that have shown significant improvements in ROM following both treatments individually. Overall, there were no significant differences between the treatment methods, which could be a result of the fact that the number of patients in each group of this study is relatively small. Additional patient reported outcome measures need to obtained with longer term follow-up in order to determine more subtle differences between the treatment options.

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