Superior Capsular Reconstruction using Dermal Allograft is a Safe and Effective Treatment for Massive Irreparable Rotator Cuff Tears: 2-year Clinical Outcomes.

PURPOSE To evaluate functional, symptomatic, and diagnostic imaging outcomes after arthroscopic superior capsular reconstruction (SCR) using dermal allograft in patients with massive irreparable rotator cuff tears. METHODS From 2015-2017, this multicenter study retrospectively evaluated patients undergoing arthroscopic SCR for treatment of symptomatic massive rotator cuff tears. Study criteria included the presence of a massive irreparable rotator cuff tear with retraction to the glenoid without diffuse bipolar cartilage loss, Grade 4 or 5 Hamada classification, and subscapularis pathology that could not be addressed. All SCR procedures were performed with neutral abduction of the arm at the time of implantation. Outcome measures included visual analog pain scale (VAS) score, the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and active forward elevation (FE) through 2 years postoperatively. Imaging analyses included radiographs, ultrasound and magnetic resonance imaging at 6-months and 1-year. RESULTS Fourteen patients met all study criteria including required follow-up. There were statistically significant improvements in VAS pain (3.3 to 0.6, P=0.001), ASES (55.0 to 86.5, P<0.0001), SANE (33.1 to 71.5, P<0.0001), and active FE (128 to 172, P=0.0005) with mean follow-up of 2.1 years. Twelve patients (86%) met the minimum clinically important difference (MCID) in VAS pain, ASES, and SANE. Thirteen grafts (93%) had ultrasonographic evidence for vascularity by 1 year postoperatively. There were two graft complications (14%) with one (7%) requiring revision to reverse total shoulder arthroplasty. CONCLUSIONS Arthroscopic SCR using dermal allograft can be a safe and effective treatment option for patients with massive irreparable rotator cuff tears with statistically significant improvements in VAS pain, ASES, SANE, and active FE at 2-years postoperatively with 93% of grafts demonstrating vascularity at 1-year postoperatively. Neutral abduction of the arm at the time of implantation resulted in positive clinical outcomes and may decrease graft failure rate.