Superior Capsular Reconstruction: Clinical Outcomes After Minimum 2-Year Follow-Up.

Superior capsular reconstruction (SCR) is performed to reduce the pain and disability caused by irreparable supraspinatus rotator cuff tears (RCTs). In this article, we discuss 9 cases of irreparable rotator cuff tears managed with arthroscopic SCR with dermal allograft. At minimum 2-year follow-up (mean, 32.38 months), the patients were prospectively evaluated on the American Shoulder and Elbow Surgeons (ASES) shoulder index, a visual analog scale (VAS) for pain, acromial-humeral distance, and ultrasonography. Patients were compared before and after surgery and against historical controls who underwent repair of massive RCTs. From before surgery to 2 years after surgery, mean ASES score improved significantly (P < .00002), from 43.54 to 86.46, and mean VAS pain score decreased significantly (P < .00002), from 6.25 to 0.38. For the historical controls at final follow-up, mean ASES score was 70.71 (P = .11), and mean VAS pain score was 3.00 (P < .05). Mean acromial-humeral distance improved from 4.50 mm before surgery to 8.48 mm immediately after surgery (P < .0008) and 7.60 mm 2 years after surgery (P < .05). Ultrasonography revealed pulsatile vessels within the allograft tissue between 4 and 8 months after surgery. One patient underwent reverse total shoulder arthroplasty (RTSA) for anterior escape; another had the graft rupture after a motor vehicle accident. Our data showed SCR with dermal allograft effectively restored the superior restraints in the glenohumeral joint and yielded outstanding clinical outcomes even after 2 years, making it an excellent viable alternative to RTSA.