Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction
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The factors affecting the anatomical and functional outcomes of arthroscopic superior capsular reconstruction (ASCR) were investigated in this study. Continuity between the posterior remnant tissue and graft, as well as medial-to-lateral anatomical graft continuity, might play a vital role in shoulder stability and functional recovery, which could be correlated with postoperative factors such as the acromiohumeral distance (AHD).
Thirty-two patients (36 shoulders) who underwent ASCR were included. The follow-up period was 24.8 ± 6.9 months. The relationship between graft continuity and preoperative, intraoperative, and postoperative factors that could affect the clinical and radiological outcomes of ASCR were investigated.
The American Shoulder and Elbow Surgeons score increased from 50.3 ± 9.1 points preoperatively to 84.0 ± 5.0 points postoperatively (p < 0.01), and the Constant score increased from 56.3 ± 9.0 to 82.8 ± 5.6 points (p = 0.02). Re-tearing occurred in 13 patients during the postoperative follow-up period. The re-tear rate was relatively high (36.1%). The gap between the immediate postoperative and preoperative AHDs was 1.6 ± 2.2 mm in the re-tear (+) group and 3.8 ± 2.8 mm in the re-tear (−) group (p = 0.02). The integrity of the posterior remnant tissue had a statistically significant and different re-tear rate (p < 0.01).
Care should be taken in patients with inadequate AHD improvement and poor posterior remnant tissue immediately postoperatively, because the possibility of re-tearing is high. Therefore, better results can be predicted when considering these factors at the time of surgery.
Level of evidence
KeywordsIrreparable rotator cuff tear Arthroscopic superior capsule reconstruction Graft thickness Subscapularis tear Posterior remnant tissue
The authors received no financial support for the research, authorship, and/or publication of this article.
Compliance with ethical standards
Conflict of interest
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
The study was approved by the ethical committee of our institution. IRB approval (No. 05-2016-010) was given by Pusan National University Yangsan Hospital, Pusan National University School of Medicine.
Informed consent was obtained from all patients.
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