Irreparable cuff tears: superior capsular reconstruction. Indications and Clinical Results

Abstract

Patients suffering from symptomatic irreparable rotator cuff tears present with pain, weakness and reduced range of motion of the involved shoulder. A subgroup of this presents with “pseudoparalysis”, which is characterized by inability to actively abduct the involved shoulder for more than 90-degree. Initial trial of non-operative treatment should be attempted if it is a chronic problem. However, for acute tear and those fails to improve after initial non-operative treatment, salvage surgery is recommended. The aims are to reduce the pain and to improve the function of patient. Among the various possible options of salvage operations, superior capsule reconstruction (SCR) using a thick fascia lata autograft seems to be a promising option for patients younger than 75-years old. The average ASES improved from 53 to 92 after SCR. The average active elevation at final follow-up was 147 degrees. The incidence of graft re-tear after SCR was 5%. Other potential complications included deep infection, pulled out of suture anchor, arthofibrosis and re-tear of repaired infraspinatus tear. There was no donor site morbidity.