Clinical outcomes and temporal changes in the range of motion following superior capsular reconstruction for irreparable rotator cuff tears: Comparison based on the Hamada classification, with or without shoulder pseudoparalysis, and status of the subscapularis tendon.

Abstract

BACKGROUND\nSuperior capsular reconstruction has recently gained popularity as a surgical solution for patients with massive rotator cuff tears or shoulder pseudoparalysis. Good clinical outcomes have been reported after superior capsular reconstruction; however, the factors that influence its clinical outcomes remain unclear. Therefore, in this study, we aimed to clarify the factors influencing postoperative outcomes after superior capsular reconstruction using tensor fascia lata graft; for which, we evaluated the Hamada grade, patients with or without shoulder pseudoparalysis, and status of the subscapularis tendon.\n\n\nMETHODS\nIn total, 54 consecutive patients with irreparable rotator cuff tears or shoulder pseudoparalysis who underwent superior capsular reconstruction between June 2014 and October 2018 were included. The enrolled patients were grouped and compared as 1) Hamada grade 2 (11 patients) and Hamada grade 3 (43 patients); 2) non-shoulder pseudoparalysis (22 patients), moderate shoulder pseudoparalysis (16 patients) and severe shoulder pseudoparalysis (16 patients). For sub-analysis, 32 shoulder pseudoparalysis patients were divided into three groups: intact subscapularis tendon (11 patients), repairable subscapularis tendon (16 patients), and irreparable subscapularis tendon (5 patients). To assess the shoulder function, the American Shoulder and Elbow Surgeons score was evaluated before surgery and 24 months postoperatively; shoulder range of motion was evaluated 2, 3, 4, 5, 6, 8, 10, 12, and 24 months postoperatively.\n\n\nRESULTS\nNo significant differences were observed in postoperative American Shoulder and Elbow Surgeons scores and the shoulder range of motion between Hamada grade 2 and Hamada grade 3, and between the non-shoulder pseudoparalysis, moderate shoulder pseudoparalysis, and severe shoulder pseudoparalysis groups. However, significant differences were observed in postoperative shoulder elevation and American Shoulder and Elbow Surgeons scores between the intact subscapularis tendon and irreparable subscapularis tendon groups (P=0.006), and between the repairable subscapularis tendon and irreparable subscapularis tendon groups (P=0.003) CONCLUSIONS: This study demonstrated that the status of the subscapularis tendon, rather than the Hamada grade or the presence or absence of shoulder pseudoparalysis, influences the clinical outcomes after superior capsular reconstruction. Therefore, reparability or intactness of the subscapularis tendon was an important factor in considering the surgical indication for superior capsular reconstruction.