Summary

Superior capsule reconstruction for reinforcement prevents postoperative retear of the repaired rotator cuff tendon and improves shoulder muscle strength.

Abstract

Background

Arthroscopic rotator cuff repair (ARCR) is a useful surgical procedure for rotator cuff tears. However, clinical outcomes and shoulder muscle strength are impaired when retears occur after surgery. Recently, superior capsule reconstruction for reinforcement of arthroscopic rotator cuff repair (SCRR) has been introduced to prevent retear after ARCR for degenerated rotator cuff tears. However, it remains unclear how much shoulder muscle strength recover after SCRR.The objective of this study was to investigate the changes in shoulder muscle strength after SCRR in patients with reparable but degenerated rotor cuff tears.

Methods

We retrospectively studied twenty patients (mean age of 68.2 years) with degenerated rotator cuff tears (19 medium and one large tears, the Goutallier grade of the supraspinatus was 2–3) who underwent SCRR using an autograft of fascia lata. Shoulder muscle strength, Japanese Orthopaedic Association (JOA) score, and shoulder pain using Visual Analog Scale (VAS) were evaluated before and at the final follow-up (mean, 23.3 months; range, 12–62 months). Shoulder muscle strength in abduction (at full-can position and at 90 degrees of shoulder abduction position), external and internal rotation at side were measured using digital handheld dynamometer (microFETII; Hoggan Scientific). Muscle strength in the affected shoulder was calculated as a percentage of that in the asymptomatic contralateral shoulder. The postoperative cuff integrity was evaluated by magnetic resonance imaging or ultrasound.

Results

In this study, all 20 patients had no retear at the final follow-up. All shoulder muscle strengths significantly increased after SCRR (abduction strength at full-can position, 46% preoperatively to 87% postoperatively; at 90 degrees of shoulder abduction position, 31% to 88%; external rotation strength, 50% to 86%; and internal rotation, 85% to 105%, all P<0.0001). JOA score was significantly improved after SCRR (62.5±10.7 points preoperatively to 92.0±6.3 points postoperatively, P<0.0001). VAS score for shoulder pain was significantly decreased after SCRR (at rest: 15.5mm preoperatively to 0.2mm postoperatively, during motion: 58.5mm to 8.1mm, both P <0.0001).

Conclusions

SCRR prevented postoperative retear of the repaired rotator cuff tendon even in cases with severely degeneration tendon. SCRR provided a significant pain relief and shoulder muscle strength returned to 86 to 105% of the uninjured contralateral side after SCRR.