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Pseudoparalysis And Subscapularis Insufficiency Are Not Contraindications For Superior Capsular Reconstruction

Pseudoparalysis And Subscapularis Insufficiency Are Not Contraindications For Superior Capsular Reconstruction

Travis Frantz, MD, UNITED STATES Marisa Ulrich, BS, UNITED STATES Joshua Scott Everhart, MD, MPH, UNITED STATES Andrew Mundy, MD, UNITED STATES Jonathan D Barlow, MD Grant L. Jones, MD, UNITED STATES Julie Bishop, MD, UNITED STATES Gregory L. Cvetanovich, MD, UNITED STATES

The Ohio State University Wexner Medical Center, Columbus, OH, UNITED STATES


2021 Congress   ePoster Presentation     Not yet rated

 

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Sports Medicine

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Summary: SCR is an effective salvage operation for massive irreparable RCT, as patients with pseudoparalysis or subscapularis insufficiency both demonstrate significant post-op improvement in forward elevation and patient reported outcomes.


Objectives
There is emerging evidence in favor of superior capsular reconstruction (SCR) as an acceptable salvage option for massive, irreparable rotator cuff tears (RCT). The purpose of this study was to examine SCR outcomes after a minimum of 2 year follow-up, and determine any risk factors predictive of outcomes.

Methods

A retrospective analysis of prospectively collected data from a single tertiary academic medical center of consecutive patients undergoing SCR for massive irreparable RCT. Patients were required to be at least 18 years of age and have intraoperative confirmation of a massive, irreparable, RCT. Patient demographics and pre-operative clinical findings were collected. Post-operative data including complications, patient satisfaction, strength and ROM, and patient reported outcomes were collected. Multivariate analysis was also performed to identify risk factors.

Results

32 patients met inclusion criteria (mean follow-up 3.2 years, minimum 2.4 years; mean age 57.3 years; 87.5% male; 43% previous operation). Pre-operative Hamada score averaged 1.5 with an AH interval distance of 6.76mm. Pre-operatively 6 patients had an ER lag (18.8%) and 6 had pseudoparalysis (18.8%). Intra-operative assessment of the subscapularis demonstrated true insufficiency in 37.5%.

Pre- and post-operative outcome comparisons demonstrated significant ROM improvement in forward elevation (FE) (116.25 vs 147.32; p=0.007), with no change in internal (IR) (p=0.60) or external rotation (ER) (p=0.10). Strength significantly improved in all planes (FE p=0.0003; IR p=0.014; ER p=0.026). Patient reported outcomes also all significantly improved (ASES - 44.17 vs 77.84: p=0.0001; VAS - 5.33 vs 2.38: p<0.0001; SANE - 25.83 vs 74.09: p=0.003). Twenty-six patients (81.2%) were completely or somewhat satisfied with surgery. At time of final follow-up 3/32 patients (9.4%) had failed SCR and been converted to a reverse total shoulder arthroplasty. There were 4 (12.5%) other reported complications (2 post-operative falls with 1 HAGL lesion and 1 distal radius fracture; 1 persistent severe pain; 1 persistent stiffness). One patient was deceased.

Multivariate analysis demonstrated the strongest predictor of post-op patient satisfaction was an increased AH interval distance (per 1mm increase, aOR 1.67; p=0.01). A lower Hamada score and increased pre-op IR strength were also found to be significant predictors of satisfaction (p=0.04 for both). However, combinations of these factors were not found to increase the predictive value. An increased AH interval distance was also predictive of improved strength in both FE (p=0.04) and IR (p=0.001).

Analysis of patients with pre-operative pseudoparalysis revealed significant improvement in post-op FE (28.3 vs 154.0; p<0.0001) and SANE score (p=0.016) with 66% patient satisfaction. However, outcome scores overall remained generally lower. Regarding subscapularis insufficiency, a significant improvement was seen in post-op in FE (108.33 vs 158.00; p=0.019) and patient reported outcome scores (p<0.005). In patients converted from SCR to rTSA (n=3) there were no distinguishing characteristics or patterns present.

Conclusion

SCR is an effective salvage operation for massive irreparable RCT. Increased AH distance improves patient satisfaction and post-op strength. Patients with pseudoparalysis or subscapularis insufficiency both demonstrate significant post-op improvement in forward elevation and patient reported outcomes.


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