Summary

Findings from this paper suggest that both BRR and SCR techniques are viable for treating large rotator cuff tears however, BRR may offer slightly superior functional benefits in the mid-term post- operative period.

Abstract

Introduction

Large or massive rotator cuff tears make up approximately 10-40% of all rotator cuff tears, presenting a significant challenge in orthopedic surgery due to the complexity and variability of the injury. The optimal treatment for these tears remains a subject of ongoing debate, with various surgical techniques proposed to restore function and reduce pain. Bridging rotator cuff reconstruction (BRR) and superior capsular reconstruction (SCR) have emerged as promising surgical options. BRR involves using a graft to bridge the defect, thereby re-establishing the continuity of the rotator cuff, while SCR utilizes a graft to restore the stability of the shoulder by reconstructing the superior capsule. Both techniques have demonstrated satisfying clinical results, but there remains limited high-quality evidence directly comparing their effectiveness. To date, only one study has previously compared BRR and SCR, highlighting a need for further research to guide clinical decision-making. The main objective of this study was to compare the functional and self-reported outcomes of patients who received BRR or SCR with human dermal allograft, providing new insights into the relative benefits of these two surgical approaches for managing large rotator cuff tears.

Methods

In this randomized control trial, 60 patients with large (> 3cm), 2-tendon rotator cuff tears were randomized into the SCR or BRR group. All patients completed patient reported outcomes (PRO) (Western Ontario Rotator Cuff Index (WORC) and Disabilities of the Arm, Shoulder, Hand (DASH)) as well as strength and range of motion (ROM) of the shoulder pre- and post-operatively (6-, 12-, 24-months). PROs and functional outcomes were statistically analyzed between and within groups at each time point, respectively. Significance was set to 0.05.

Results

Patients in both groups had similar demographics and pre-operative conditions (p>0.05). Although WORC and DASH scores were not statistically different post-operatively, the BRR group had consistently lower scores (~12) at each time point. Both SCR and BRR groups showed significant post-operative improvements (p<0.05), with the BRR group exhibiting significantly greater improvement (p<0.05). Both groups, on average exceeded the minimally clinical important difference (MCID) for WORC (11.7) and DASH (10.2) at each follow-up time point respectively from pre-op. For shoulder strength, both groups showed significant gains in flexion, abduction, internal, and external rotation at 12 and 24 months, but not at 6 months. No significant differences in strength or ROM were found between the groups at any time point.

Conclusions

Both BRR and SCR using human dermal allograft effectively improve functional and self-reported outcomes in patients with large rotator cuff tears. Despite the lack of statistically significant differences in post-operative WORC and DASH scores between the two groups, the BRR group demonstrated consistently greater improvements in functional outcomes and shoulder strength, particularly beyond 6 months post operation. Both groups exceeded the MCID thresholds for WORC and DASH scores at all follow-up intervals, indicating meaningful clinical benefits for patients. These findings suggest that while both surgical techniques are viable for treating large rotator cuff tears, BRR may offer slightly superior functional benefits in the mid-term post- operative period. Further long-term studies are needed to validate these findings and determine if these trends persist over time.