Summary

For irreparable rotator cuff tears, arthroscopic SCR restored shoulder function and relieved shoulder pain, with high rates of return to recreational sports and physically demanding work, and it maintained significant improvements in clinical and structural outcomes for at least 10 years after surgery.

Abstract

Introduction

Short-term follow-up studies have reported favorable clinical outcomes after arthroscopic superior capsule reconstruction (SCR) for irreparable rotator cuff tears. Our objective here was to assess whether these positive outcomes are maintained long-term and whether cuff tear arthropathy worsens over time after fascia lata autograft SCR.

Methods

This study analyzed data collected prospectively from 34 consecutive patients (36 affected shoulders) with irreparable rotator cuff tears who underwent arthroscopic SCR from 2007 through 2011. Active shoulder range of motion (ROM) and American Shoulder and Elbow Surgeons (ASES), Japanese Orthopaedic Association (JOA), and Visual Analog Scale (VAS) scores were evaluated before SCR and at 1 year, 5 years, and 10 years after surgery; rates of return to participation in sports and physically demanding work were determined as well. In addition, radiography and MRI data were collected before surgery and at 3 and 6 months and at 1, 2, 3, 4, 5, and 10 years afterward. Acromiohumeral distance (AHD) and Hamada grade (stage of cuff tear arthropathy) were evaluated by using radiography. We defined Hamada grades 3 and 4b as acetabularization and grades 4a and 4b as glenohumeral osteoarthritis. Graft survival rate and thickness were assessed by using T2-weighted MRI.

Results

Compared with presurgery values, ASES and JOA scores and active ROM (elevation and external rotation) were increased significantly at 1 year after SCR (P < 0.001) and maintained throughout follow-up. At 10 years after SCR, 88% (15 of 17 patients) of workers with physically demanding jobs and 90% (9 of 10 patients) of sports players still participated in these activities. Graft survival rate was 94% (34 of 36 shoulders) at 1 year after SCR, 92% (33 of 36 shoulders) at 2 to 4 years, and 89% (32 of 36 shoulders) at 5 to 10 years. In healed grafts, graft thickness was maintained for at least 10 years after SCR (7.8±2.0 mm at 3 months after SCR, 7.8±1.6 mm at 10 years). The incidence of acetabularization (affected shoulder, 9%; unaffected shoulder, 6%) and glenohumeral osteoarthritis (affected shoulder, 28%; unaffected shoulder, 16%) during the 10 years after SCR did not differ between affected and unaffected shoulders. The complication rate was 2.8% (1 of 36 patients, anchor pull-out).

Conclusion

For irreparable rotator cuff tears, arthroscopic SCR restored shoulder function and relieved shoulder pain, with high rates of return to recreational sports and physically demanding work, and it maintained significant improvements in clinical and structural outcomes for at least 10 years after surgery. In addition, graft healing completely prevented any progression of cuff tear arthropathy. Arthroscopic SCR is an effective surgical option for irreparable rotator cuff tears and retains positive outcomes for at least 10 years.