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Sources, Quality, and Reported Outcomes of Superior Capsular Reconstruction: a Systematic Review.

ABSTRACT: PURPOSE:Superior capsular reconstruction (SCR) has gained attention as a potential treatment option for those with massive irreparable rotator cuff tears without significant arthritis. The aim of this systematic review is to review and evaluate the current sources and quality of SCR literature as well as reported outcomes. METHODS:Three databases (PubMed, Ovid [MEDLINE], and EMBASE) were searched independently and in duplicate to systematically screen the literature. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist guided the reporting and data abstraction. The results are presented in a narrative summary fashion using descriptive statistics. RESULTS:Overall, 58 studies were identified, including 304 different patients. There was a rapid increase in the number of publications observed over the past 3 years, with the most dramatic single-year increase noted from 2017 to 2018 (175% increase). There are no level 1 studies, and 95% of the included studies were level 4 and 5 evidence. Comparing pre-operative to post-operative pooled-weighted mean outcome scores, the American Shoulder and Elbow Surgeons score improved from 44.2 to 84.8, the Visual Analogue Scale from 5.0 to 1.5, and acromiohumeral distance from 6.5 to 8.4 mm, respectively. Range of motion in forward elevation also improved from 111° to 152°. Among studies reporting, the complication rate was 13.4% with a revision surgery rate of 4.3%. CONCLUSION:Over the past 3 years there has been considerable growth in the number of publications of publications related to SCR. Despite a lack of high-quality clinical evidence, preliminary available evidence does suggest promising results both functionally and radiographically. There is a need for future higher-quality research such as large randomized controlled trials to improve our current understanding of the benefits of SCR.

SUBMITTER: Ekhtiari S

PROVIDER: S-EPMC6543044 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Sources, Quality, and Reported Outcomes of Superior Capsular Reconstruction: a Systematic Review.

Ekhtiari Seper S Adili Anthony F AF Memon Muzammil M Leroux Timothy T Henry Patrick P Bedi Asheesh A Khan Moin M

Current reviews in musculoskeletal medicine 20190601 2

<h4>Purpose</h4>Superior capsular reconstruction (SCR) has gained attention as a potential treatment option for those with massive irreparable rotator cuff tears without significant arthritis. The aim of this systematic review is to review and evaluate the current sources and quality of SCR literature as well as reported outcomes.<h4>Methods</h4>Three databases (PubMed, Ovid [MEDLINE], and EMBASE) were searched independently and in duplicate to systematically screen the literature. The Preferred ...[more]

PMID: 30927142

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Project description:PurposeTo screen manuscripts that discuss rehabilitation protocols for patients who underwent superior capsular reconstruction (SCR) to elucidate whether a standard rehabilitation algorithm exists for SCR.MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (i.e., PRISMA) guidelines. PubMed (MEDLINE) and Embase were searched using pertinent Boolean operation terms "superior capsular reconstruction" and "rotator cuff repair rehabilitation," and articles that included rehabilitation protocols following superior capsular reconstruction surgery were reviewed. Two independent reviewers performed the search and quality assessment.ResultsA total of 549 articles were yielded after our database search. Fourteen studies fulfilled our inclusion criteria and were included in the review. Study designs included 9 editorials, 3 case series, and 2 case reports. Each study included in this review used a unique rehabilitation algorithm that posed significant variability between the protocols. Four phases were identified to summarize each protocol and were used as a basis of discussion-sling versus brace time (3-6 weeks for comfort/removal vs complete immobilization), passive range of motion (immediately after surgery to initiation at 6 weeks), active range of motion (4-8 weeks), and strengthening/return to full activity (12-52 weeks). Initiation of rehabilitation, length of time spent in each phase, types of exercises, and overarching goals for return to function were significantly variable and were decided upon by the surgeon based on current massive rotator cuff repair protocols. Presently, there is no standard rehabilitation protocol for SCR.ConclusionsSCR is a relatively new procedure that is gaining rapid popularity with promising outcomes. Based on our review, there is no standard rehabilitation protocol in place; thus, it is not possible to recommend an evidence-based rehabilitation protocol following SCR at this time.Level of evidenceLevel V, systematic review of Level IV and V studies.

Project description:PurposeWe systematically reviewed the literature to compare the clinical and radiologic outcomes and retear rates of superior capsular reconstruction (SCR) using fascia lata autograft (FLA) versus human dermal allograft (HDA) in cases of massive irreparable rotator cuff tears.MethodsSearches of Pub Med and Cochrane Library identified clinical studies addressing SCR using FLA and HDA. Two reviewers independently screened the titles, abstracts and full texts to extract data from eligible studies. Reported outcome measures were descriptively analyzed.ResultsA total of 6 studies with 2 study groups satisfied the inclusion criteria. The number of shoulders in the HDA group was 155, and in the FLA group, the number was 140 shoulders. The mean age at time of surgery for the HDA group and the FLA group was 60.49 years and 65.8 years, respectively, and the mean follow-up was 15.2 months and 44.6 months, respectively. Active elevation improved from of 121°-130° to 158°-160° in the HDA group and from 74.8°-133° to 130.4°-146° in the FLA group. Active external rotation improved from 36°-45° in the HDA group and from 13°-28° to 30°-43° in the FLA group. The Visual Analog Scale for pain improved from 4-6.25 to 0.38-1.7 points in the HDA group, whereas in the FLA group, it improved from 6-2.5 points. In the HDA group, American Shoulder and Elbow Surgeons scores improved from 42-52 to 77.5-86.5, whereas in the FLA group scores improved from 35-54.4 to 73.7-94.3. The acromiohumeral distance improved in both groups. The retear rate was 3.4%-55% in the HDA group and 4.5%-29% % in the FLA group.ConclusionsArthroscopic SCR for massive, irreparable rotator cuff tears using both fascia lata allograft and human dermal allograft leads to improvement in clinical outcomes and radiologic outcomes. There is a lower retear rate in fascia lata allografts. The current literature is heterogeneous and has low levels of evidence.Level of evidenceLevel IV, systematic review of level IV studies.

Project description:PurposeThe purposes of this study were to evaluate the clinical outcomes (with the minimum mean follow-up period of 2 years) of arthroscopic superior capsular reconstruction (ASCR) using different grafts for massive irreparable rotator cuff tears (MIRCTs) and to explore whether margin convergence in ASCR affects range of motion (ROM) outcomes.MethodsThis systematic review was registered in PROSPERO and was then conducted following PRISMA guidelines by searching the databases: MEDLINE, EMBASE, Web of Science, and Cochrane Library database before April 2021. These literature searches investigating the clinical outcomes of ASCR were included. The methodological quality of included studies was assessed using the MINORS criteria. The data, including margin convergence, patient-reported outcome scores, range of motion, and complications, were extracted and analyzed. The minimal clinically important differences (MCID) criteria was used to define clinical significance.Results15 studies met the inclusion criteria. All studies reported statistically significant improvements in visual analog scale scores (range: 2.07 to 7.1) and American Shoulder and Elbow Surgeons scores (range: 18.1 to 58). Significant improvements of Constant scores were noted in 4 of 5 reporting studies (mean improvement ranged from 14.64 to 50.79). Active forward flexion/elevation (11 studies), active abduction (4 studies), and active external rotation (8 studies) displayed improvements in all reporting studies, with mean changes ranging from 12 to 73.68, 19 to 89.21, and 1 to 24.74, respectively. The mean change of postoperative acromiohumeral distance ranged from -0.86 mm to 3.2 mm in 9 studies. The postoperative complication rate of ASCR ranged from 4.5% to 47.6%. The anterior margin convergence in SCR was associated with a relatively poor improvement in active external rotation.ConclusionsASCR contributes to significant improvements in patient-reported clinical outcomes and ROM at follow-up after a mean of more than two years, emerging as a viable option for patients with MIRCTs. The anterior margin convergence should be prudently chosen, especially in ASCR using fascia lata autograft, on account of the probable restriction on postoperative active external rotation.Level of evidenceLevel IV, systematic review of Level III and IV studies.

Project description:Superior capsular reconstruction is a common treatment option for irreparable rotator cuffs. Arthroscopic surgery procedures mostly use anchor-based methods. However, difficulty in preoperative graft measurement and intra-articular knot-tying present an obstacle for most sport surgeons. Complementing the known advantages of the transosseous technique in rotator cuff repair, a feasible, economical arthroscopic transosseous superior capsular reconstruction technique is described in this Technical Note. This procedure results not only in similar fixation strength and stability and greater bone stock but also in greater cost effectiveness due to using fewer anchors. This Technical Note describes the procedure in detail and compares it with conventional procedures. Technique Video Video 1 Patients undergo surgery in the beach-chair position. A standard posterior portal is created for arthroscopic visualization. Intra-articular management, including debridement or labral reattachment, is performed via the anterior portal. Then, the scope is shifted to the subacromial space from the posterior portal, and bursectomy is undertaken via the anterior portal. The irreparable cuff tear edge is debrided to approach the medial aspect of the superior labrum. Two inlets are created: one anterior inlet near the biceps groove and one 2-cm inlet posterior to the anterior tunnel inlet. The ETHIBOND 5-0 suture needle tip is visible through the posterior portal and is grasped using a curved needle holder introduced via the lateral portal. The needle tip is introduced into the medial row inlet with a needle holder, and the lateral humeral cortex is pierced. The scope is shifted to the subdeltoid space for retrieval of the needle tip using the curved needle holder through the lateral portal. The ETHIBOND suture is left in the tunnel for shuttle purposes. Next, 3.7-mm all-suture anchors are fixed at the superior glenoid. Single-limb sutures are retrieved from 2 anchors outside via the lateral portal, and the proximal allograft edge is pierced. The graft is delivered along two sutures of glenoid-fixed anchors using a knot pusher. Glenoid graft fixation is achieved by tying knots at each all-suture anchor. After corner knots are tied, an extra knot is tied at the center of the proximal graft edge using each of the corner sutures. Suture tunnel entry points are located using the scope to determine the following piercing site on the graft. The graft undergoes intra-articular piercing, and tunnel sutures are relayed on the proximal and distal row using a tissue penetrator and shuttle suture manipulation. Four sutures are passed through 2 suture tunnels, one of which crosses 2 tunnels in the proximal region to form a medial row of footprint sutures. The shoulder is placed in a neutral position to lessen suture tension. The lateral row is tied first on the lateral cortex, simultaneously applying tension to suture tunnel exits and the medial row. The superior limb of the posterior cross-link suture and the inferior limb of the anterior cross-link suture are retrieved and tied together. The inferior limb of the posterior cross-link suture and superior limb of the anterior cross-link suture are tied to finish the cross-link construction. The final “hourglass” shape construction is achieved after tuberosity fixation.

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Sources, Quality, and Reported Outcomes of Superior Capsular Reconstruction: a Systematic Review.

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Sources, Quality, and Reported Outcomes of Superior Capsular Reconstruction: a Systematic Review.

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