Summary

The purpose of this study was to compare clinical outcomes between SCRR group and a matched ARCR group using propensity score. No significant differences were found in ASES scores and ROM between both groups. Retear rate were 7.7% in SCRR group, 15.4% in ARCR group, respectively. These suggest that SCRR may be a more effective method for achieving successful rotator cuff surgery.

Abstract

Background

In most cases with medium-sized rotator cuff tears, arthroscopic rotator cuff repair (ARCR) achieves successful clinical outcomes. However, degenerative or thin tendon edges are believed to pose a potential risk for retear. To minimize this risk, we have been adopting ARCR with superior capsular reconstruction for reinforcement (SCRR). Simple comparisons between the two methods may be biased due to differences in tear size, which can affect clinical outcomes. Therefore, the purpose of this study was to compare clinical outcomes and cuff repair integrity between the SCRR group and a matched ARCR group.

Materials And Methods

This study included 120 patients (81 males, 39 females; mean age 69.4 years; mean tear size 18.5 mm) who underwent ARCR, and 15 patients (10 males, 5 females; mean age 68.4 years; mean tear size 22.5 mm) who underwent SCRR between September 2015 and April 2023. According to Mihata et al., the medial end of the autologous fascia lata graft was fixed to the glenoid as a deep layer for reinforcement. The native torn rotator cuff was then fixed to the greater tuberosity together with the graft using the suture bridge technique. To reduce bias, propensity score matching was performed based on sex, age, and tear size. This process resulted in 13 matched patients in each group: ARCR (11 males, 2 females; mean age 64.5 years; mean tear size 20.8 mm) and SCRR (9 males, 4 females; mean age 68.3 years; mean tear size 21.4 mm). Clinical outcomes before surgery and at final follow-up were evaluated using the American Shoulder and Elbow Surgeons (ASES) score. The integrity of cuff repair was determined using Sugaya’s classification on MRI. Retear patterns were further categorized using Cho’s classification.

Results

Both groups showed significant improvement in ASES scores postoperatively. In the SCRR group, there were also significant improvements in flexion, abduction, and external rotation after surgery. Among the SCRR group, a retear was observed in one patient (7.7%), classified as Cho type 1. Additionally, we also encountered one patient with only a graft tear in the SCRR group, indicating that the continuity of the repaired native rotator cuff was barely preserved. In contrast, the ARCR group had 2 cases of retear (15.4%), both classified as Cho type 2. When comparing the two groups, no significant differences were found in the preoperative and postoperative ASES scores or ROM.

Conclusion

Although no significant differences were observed between the SCRR and ARCR groups in terms of clinical outcomes, the retear rate in the SCRR group appeared to be lower than that in the ARCR group. This suggests that SCRR may be a more effective method for achieving successful rotator cuff surgery.