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.
Keywords: Massive rotator cuff tear; Shoulder capsule; Superior capsular reconstruction; Superior capsule repair.
Conflict of interest statement
Seper Ekhtiari, Anthony Adili, Muzammil Memon, Tim Leroux, Patrick Henry, and Moin Khan each declare no potential conflicts of interest.
Asheesh Bedi is a consultant and received personal fees from Arthrex.
Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears: A Systematic ReviewRK Zastrow et al. Arthroscopy 35 (8), 2525-2534.e1. PMID 31395196. - ReviewPreliminary results of SCR show consistent improvement in shoulder functionality and pain reduction. However, a decrease in postoperative AHIs indicates dermal allograft …
Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears: A Systematic Review of Biomechanical and Clinical Outcomes by Graft TypeJL Makovicka et al. J Shoulder Elbow Surg. PMID 31522915. - ReviewSCR is emerging as a viable surgical option to address the irreparable rotator cuff tear. Biomechanical studies suggest that the humeral head-stabilizing effect of SCR ap …
Arthroscopic Superior Capsular Reconstruction for Massive, Irreparable Rotator Cuff Tears: A Systematic Review of Modern LiteratureM Catapano et al. Arthroscopy 35 (4), 1243-1253. PMID 30878327. - ReviewArthroscopic SCR represents an accepted surgical option for patients with MIRCTs, with short-term improvements shown in pain, range of motion, and function. Although earl …
Outcome Comparison of Graft Bridging and Superior Capsule Reconstruction for Large to Massive Rotator Cuff Tears: A Systematic ReviewJ Lin et al. Am J Sports Med 363546519889040. PMID 31766858.In general, GB showed significantly better clinical and functional outcomes postoperatively than SCR, with a similar complication rate. The available fair-quality evidenc …
Superior Capsular Reconstruction for Massive Rotator Cuff Tear Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic ReviewKR Sochacki et al. Arthroscopy 35 (4), 1269-1277. PMID 30878330. - ReviewArthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears results in statistically significant and clinically significant improvement in pa …