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Does arthroscopic superior capsular reconstruction keep its promises – an Austrian short-term prospective clinical and radiological analysis and comparison to debridement and partial repair in irreparable rotator cuff tears
ESSKA Academy. Heuberer P. Nov 8, 2019; 286380
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Does arthroscopic superior capsular reconstruction keep its promises – an Austrian short-term prospective clinical and radiological analysis and comparison to debridement and partial repair in irreparable rotator cuff tears

ESA Free Oral Presentations

Topic: Biological Augmentation

Heuberer P., Pauzenberger L., Laky B., Eigenschink M., Ostermann R., Anderl W., AURROM-Austrian Research Group for Regenerative and Orthopaedic Medicine
AURROM-Austrian Research Group for Regenerative and Orthopaedic Medicine, Vienna, Austria

Objectives: Massive irreparable rotator cuff tears may cause severe functional impairment and pain as a result of superior glenobumral instability. Accepted arthroscopic treatment options are debridement (DB) and partial tendon repair (PR). However, studies showed that only repair of the superior capsule (SCR) could restore glenohumeral stability and function. The aim of this study was to investigate if reported functional and radiological results after SCR could be reproduced and compare them to DB and PR.
Methods: First, 22 consecutive patients (mean age of 66.9 years; range, 56 to 76 years) with irreparable postero-superior rotator cuff tears were prospectively enrolled. All patients underwent arthroscopic SCR using a human dermal allograft. Irreparable subscapularis tendon tear or cuff tear arthropathy > Hamada 3° were an exclusion criteria. Magnetic resonance images (MRI) were taken before and 12 months after surgery. Second, the results were compared to patients after DB or PR extracted from our shoulder database using the same in- and exclusion criteria. Functional and subjective outcome was evaluated using range of motion (ROM), Constant score (CS), visual analogue scale (VAS) for pain and the subjective shoulder value (SSV) 2-3 years postoperative.
Results: After SCR MRI evaluation revealed intact grafts in 71% of patients. At the clinical follow-up patients showed significant improvements from baseline to postoperative regarding all outcome scores (p< 0.01). Preoperatively 57% of patients presented with pseudopralysis, which was found to be reversed postoperatively. From our shoulder database, 23 patients after DB and 17 after PR could be extracted with similar baseline parameters. All treatments showed a significant improvement from pre- to postoperative in all clinical parameters. Only strength showed a significant better result after SCR (11.9±6.6) compared to DB (6.1±4.5, p-value=0.002) or PR (4.4±2.9, p-value< 0.001). No differences could be detected between DB or PR.
Conclusion: SCR has shown to restore clinical function, while healing of the allograft patch seems to be the weak link of this surgery. Nevertheless, compared to DB or PR, especially in cases without preoperative pseudoparalysis only strength was significantly improved after SCR. Keeping in mind the cost and difficulty of such a surgical technique, indications must be clearly defined and treatment with DB or PR should be favoured in patients with good preoperative ROM.
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