Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction

Shoulder
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Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusion

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

IV.

Keywords

Irreparable rotator cuff tear Arthroscopic superior capsule reconstruction Graft thickness Subscapularis tear Posterior remnant tissue 

Notes

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.

Ethical approval

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

Informed consent was obtained from all patients.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Yangsan HospitalPusan National University School of MedicineYangsanSouth Korea
  2. 2.Department of Orthopedic Surgery, Inje University Busan Paik HospitalInje University College of MedicineBusanSouth Korea

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