by Elizabeth Hofheinz, M.P.H., M.Ed.
A group of researchers from Hospital for Special Surgery (HSS) in New York has explored the outcomes of a salvage procedure frequently used for rotator cuff re-tears: superior capsular reconstruction (SCR). A total of 72 patients underwent this surgery with dermal allograft.
Their study, “Clinical Outcomes following Arthroscopic Shoulder Superior Capsular Reconstruction,” is available online as part of the AAOS 2020 Virtual Education Experience.
Asked why, of all of the salvage procedures, they chose to study SCR, co-author Joshua S. Dines, M.D., a sports medicine surgeon at HSS, told OSN, “While there are salvage procedures for many types of pathologies, I chose to study SCR for several reasons. First, as a shoulder specialist, it is something I am interested in. We see a significant number of patients with complicated rotator cuff tears or re-tears that may not heal if operated on using standard rotator cuff repair techniques. Prior to the invention of the SCR, many patients required a reverse shoulder replacement.”
“While reverse shoulder replacements work great in many patients, they don’t last forever so using them in younger patients becomes problematic. Finding a solution to this significant clinical problem was something I was very interested in. When SCR came about it provided hope for these most difficult situations. There was a lot of excitement initially. However, with any newer technique, it is always important to step back after doing some of them to rigorously analyze the results to make sure that patients are benefitting from the technique as much as we expect them to. I think this was the main impetus for the study…..to critically analyze our results which will help us do a better job selecting patients who are good candidates for the procedure and to be able to counsel them better with regards to postoperative expectations.”
“We looked at our first 72 patients, which makes this a relatively large series. It was a difficult patient group in that more than 40% had undergone previous rotator cuff repair. Despite this, looking at short term results, the overwhelming majority of patients did well clinically. Based on this, I think the SCR is a very viable option for patients with difficult rotator cuff pathologies even those who underwent previous repair.”
“After surgery, the overwhelming majority of patients demonstrated significant improvements in forward elevation, abduction and external rotation through their pre- and post-operative active range of motion,” said the HSS news release.
Regarding additional work to be done in this area, Dr. Dines told OSN, “Future studies will focus on three areas: 1. Improving the repair construct: while the overall concept of the SCR is the same for all surgeons, people have slightly different ways to fix the graft or even use different grafts. We are doing studies in our biomechanics lab to try to figure out the best/strongest biomechanical construct for the SCR. 2. Delineating indications: we are getting more granular with our data to figure out which patients are the best candidates for the procedure. Are their certain variables that make a given patient a better or worse candidate for the procedure? 3. Long term outcomes: because this is a relatively new procedure, studying the longer term results is critical.”