Summary

Lateral re-tear occurred mainly after superior capsular reconstruction surgery for massive rotator cuff tear. When the lateral side tear developed, the frequency of reoperation was high because of poor clinical results.

Abstract

Background

Recently, arthroscopic superior capsular reconstruction (ASCR) has been introduced as an alternative treatment for patients with massive irreparable rotator cuff tears. However, the results of ASCR are still limited, and little information about re-tear after ASCR or subsequent treatment is reported.

Purpose

This study aimed to investigate the re-tear rate for patients who underwent ASCR and analyze the clinical outcomes of treatments performed for a re-tear.
Study Design: Case-control study; Level of evidence IV

Methods

This study was a retrospective analysis of prospectively collected data from 42 patients (46 shoulders) who underwent ASCR between March 2015 and April 2018. All patients were divided into two groups, namely, the re-tear (-) group (30 shoulders) and the re-tear (+) group (16 shoulders). The preoperative and postoperative clinical and radiological results were compared between the two groups. The re-tear pattern and treatment outcomes of the re-tear group were analyzed.

Results

The overall incidence of re-tear (+) was 35% (16/46). No difference in the preoperative demographic data and clinical data was found between the two groups. Preoperative MRI data showed that the preoperative Goutallier grade of subscapularis differed from 1.5±1.1 in the re-tear (-) group and 2.5±1.3 in the re-tear (+) group (p=0.016). In the re-tear (+) group, there were 10 cases of lateral side tears, three cases of midsubstance tears, two cases of medial side tears, and one case of medial and lateral tears. Reoperation was performed in eight patients who had lateral insertion tear.

Conclusion

Overall, the clinical scores improved after ASCR in patients with massive irreparable rotator cuff tears. However, 36% (16/46) of the patients showed re-tear (+), and lateral side re-tear occurred in 68% (11/16). The clinical outcome of the patients with preoperative subscapularis atrophy or postoperative lateral side re-tears was worse and reoperation was often required. Therefore, it is important to keep in mind that the lateral side is firmly fixed during the ASCR procedure.