Superior Capsular Reconstruction for Massive Irreparable Cuff Tears: A Systematic Review for Clinical & Functional & Radiological Outcomes
Ahmed El Saeed, Ashraf El Sedaway, Andrew Magdy Youssef- General Medicine
Background
Massive rotator cuff tears (MRCT) are defined as a full-thickness tear of at least two tendons or measuring greater than five centimeters in diameter in the coronal plane. They represent about 20% of all rotator cuff tears and 80% of recurrent tears.
Aim of the Work
The treatment of massive irreparable cuff tears (MIRCT) is considered a consistent challenge for the orthopedic surgeons regarding the best management and the postoperative outcomes.
Patients and Methods
Search were conducted using the following databases: MEDLINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails (The Cochrane Library). Data will be independently extracted by two reviewers and cross-checked.
Results
In radiological parameters, this review makes radiological assessment based on acromiohumeral distance and MRI graft integrity. AHD showed significant improvement in mean change postoperatively rather than preoperatively. As regarding MRI graft integrity, despite this high failure rate (20%) most patients still experienced improved functional outcome scores with two studies reporting no significant differences in functional scores between the intact and re-tear group. but on the other hand Denard et al. demonstrated that 100% of patients with healed grafts had a successful outcome compared to 45.5% when the graft did not heal (p = 0.009).
Conclusion
Not all patients with massive cuff tears are appropriate candidates for complex joint preservation surgery such as SCR because of age, comorbidities, and ability to participate in the lengthy postoperative rehabilitation, so rTSA is an optimal option for elderly, low-demand patients who can benefit from the speed of surgery and rehabilitation with rTSA for massive rotator cuff tears without arthritis.