How Effective Is Superior Capsular Reconstruction?

Superior capsular reconstruction is an effective salvage operation for massive irreparable rotator cuff tears, according to a new study.

The researchers found that patients with pseudoparalysis or subscapularis insufficiency experienced significant postoperative improvement in forward elevation and patient-reported outcomes.

The study, “Superior Capsular Reconstruction: A Salvage Option for Massive Irreparable Rotator Cuff Tears with Pseudoparalysis or Subscapularis Insufficiency,” evaluated superior capsular reconstruction outcomes after minimum 2-year follow-up and sought to determine which factors affected outcomes.

The findings were published in the February 2022 issue of the journal Arthroscopy.

Forty patients with a mean age of 57.3 years were included in the study. The majority of the patients were male. The minimum follow-up, however, was only reached for 32 patients.

The researchers collected data on patient demographics, preoperative clinical findings, as well as postoperative data which included complications, patient satisfaction, strength and range-of-motion, and patient-reported outcomes.

Overall, the Hamada score was 2 or lower in 88% of the patients with average acromiohumeral interval distance of 6.8 mm. Preoperatively, 6 patients had external rotation lag and 6 had pseudoparalysis.

The researchers determined true insufficiency in 38%. Patients experienced significant improvement in forward elevation 31° increase (p = .007) and strength in all planes (all p < .05).

Patient-reported outcomes also significantly improved. The American Shoulder and Elbow Surgeon score had a 34-point increase; the Visual Analog Scale score 2.9-point decrease; and alpha-numeric evaluation a 48-point increase.

Twenty-six patients were completely or somewhat satisfied with surgery. Nine patients failed superior capsule reconstruction and converted to reverse total shoulder arthroplasty. In addition, 4 or 13% of the patients reported complications. In two cases the patients fell.

Patients with pseudoparalysis had significant improvement in post-operative forward elevation (28 vs 154°: p < .0001) and Single Assessment Numeric Evaluation score (p = .016) with 66% patient satisfaction.

The researchers, however, noted that outcome scores remained lower than superior capsule reconstruction without pseudoparalysis.

In addition, in patients with subscapularis insufficiency, improvements were also seen in postoperative forward elevation and patient-reported outcome scores (p < .005).

“In patients converted from superior capsule reconstruction to reverse total shoulder arthroplasty (n = 3), there were no distinguishing characteristics present,” they wrote.

“Superior capsular reconstruction is an effective salvage operation for massive irreparable rotator cuff tear. Patients with pseudoparalysis or subscapularis insufficiency demonstrate significant postoperative improvement in forward elevation and patient-reported outcomes.”

The study authors included Marisa N. Ulrich of Ohio State University Wexner Medical Center, Travis L. Franz, M.D., of TRIA Orthopaedic Center, Sports Medicine & Shoulder Surgery, Joshua S. Everhart, M.D., M.P.H. of Indiana University School of Medicine, Jonathan D. Barlow, M.D., of the Mayo Clinic, Grant L. Jones, M.D., of TRIA Orthopaedic Center, Sports Medicine & Shoulder Surgery, Julie Y. Bishop, M.D., also of TRIA and Gregory L. Cvetanovich, M.D., of Ohio State Sports Medicine Research Institute.