Summary

In treatment of massive rotator cuff tears with high-grade fatty degeneration of the infraspinatus, superior capsular reconstruction might not be superior to patch procedure for graft integrity.

Abstract

Purpose

This study compared clinical and radiographic outcomes after superior capsular reconstruction (SCR) and fascia lata autograft patch procedure (PG) in treatment of large to massive rotator cuff tears (RCTs).

Methods

This study included 42 shoulders in 42 patients who underwent the patch graft procedure (Group PG) and 42 patients who underwent SCR (Group SCR) for irreparable large or massive RCTs. Clinical assessments were assessed using Constant score ASES Scores. We used magnetic resonance imaging (MRI) evaluation especially focusing on the patch integrity or retears of the native cuff tendons (the infraspinatus and/or subscapularis tendons).. The repair integrity was classified as intact or nonintact based on the appearance of the native cuff, the tendon-graft interface, and the graft at the anatomic footprint on the humeral head. Intact repairs showed no high signal intensity areas in the native cuff, the tendon-graft interface, or the graft-humeral interface. In addition, we assessed the presence of Sugaya 5 retear (a major discontinuity in each MRI image).

Results

There were no significant differences in any variables between the 2 groups except for follow-up
period, mediolateral tear size, anterior to posterior tear size, biceps tenodesis (n), preoperative supraspinatus Goutallier stage 3 or 4 (%), preoperative subscapularis Goutallier stage 3 or 4 (%).
Postoperative MRI showed that 13 of 42 (31.0 %) shoulders had intact repairs in PG group and 27 of 42 (64.3 %) shoulders had intact repairs in SCR group (P = .004). In addition, Postoperative MRI showed that 19 of 42 (45.2 %) shoulders had shoulders with Sugaya 5 retear in PG group and 9 of 42 (21.4 %) shoulders had shoulders with Sugaya 5 retear in SCR group (P = .002).
Compared with preoperative scores, the mean Constant, ASES scores were significantly improved at the final follow-up in both groups (P < .001) in the two groups. At the final follow-up, the mean Constant and ASES scores were higher in group SCR than in group PG without significance (71.8 vs 70.0; P = .474 for the Constant score, 84.4 vs 79.1; P = .118 for the ASES score).


Stepwise multivariate logistic regression analysis identified the treatment group (PG vs SCR) and GFDI as the significant predictive factors for shoulders without intact repairs (odds ratio, 3.323; 95% CI, 1.271-8.691; P = .014 for the treatment group, odds ratio, 3.753; 95% CI, 1.374-10.253; P = .010 for GFDI, respectively). In addition, the analysis identified the presence of preoperative ISP Stage 3 or 4 and SSP stage 3 or 4 as the significant predictive factors for shoulders with Sugaya 5 retears (odds ratio, 6.791; 95% CI, 2.345-19.662; P < .001 for the ISP Stage 3 or 4, odds ratio, 5.681; 95% CI, 1.109-29.090; P = .037 for the SSP Stage 3 or 4, respectively).

Conclusions

Operative treatment of shoulders with preoperative ISP stage 3 or 4 may be risky for occurrence of large retear after performing SCR or patch procedure, thought the two scores were significantly improved at the final follow-up in the two groups.