Comparison of clinical outcomes of superior capsular reconstruction and reverse shoulder arthroplasty for irreparable rotator cuff tears in patients aged 65 and older: A propensity score-matched study

Abstract

Background/objective

In young patients with massive irreparable rotator cuff tears (MRCTs), superior capsular reconstruction (SCR) is a viable surgical treatment option, whereas SCR and reverse shoulder arthroplasty (RSA) are reliable treatments for irreparable MRCTs in patients aged >65 years. This study aimed to compare the outcomes of arthroscopic SCR and RSA in patients with MRCTs without arthritis aged ≥65.

Methods

This retrospective comparative study included 202 patients ≥65 years old with irreparable MRCTs who had undergone either SCR using a 3–4 mm single-layer human acellular dermal matrix or RSA between January 2017 and December 2021. All patients underwent at least 2 years of postoperative follow-up. Propensity score matching was performed based on age, sex, dominant-arm involvement, follow-up duration, body mass index, pseudoparalysis, bone mineral density, global fatty degeneration index, and rotator cuff tear size. A total of 44 matched patients (22 with SCR and 22 with RSA) were included in the analysis. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Single Assessment Numeric Evaluation (SANE), and active range of motion (ROM). Postoperative radiological evaluations were performed to assess healing failure.

Results

No significant differences were observed in the preoperative demographic data, clinical outcomes, or active ROM between the SCR and RSA groups. At the final follow-up, significant improvements in pain, ROM, and functional outcomes were observed in both groups. However, the SCR group had significantly higher ASES scores (88.6 ± 7.5 vs. 81.0 ± 12.0; p = 0.02), Constant scores (72.4 ± 8.9 vs. 65.0 ± 7.0; p < 0.01), and SANE scores (87.2 ± 8.4 vs. 81.2 ± 6.8; p = 0.01) than the RSA group. Postoperative active ROM was also superior in the SCR group for forward flexion (157.7 ± 21.2° vs. 141.2 ± 16.0°; p < 0.01) and internal rotation (8.1 ± 1.4 vs. 9.5 ± 2.0; p = 0.01) compared with the RSA group. Healing failure occurred in 6 patients in the SCR group (27.3 %).

Conclusion

SCR and RSA resulted in reliable improvements 2 years post-surgery in patients aged >65 years without glenohumeral joint arthritis. However, SCR provided superior outcomes in terms of forward flexion, internal rotation, and functional scores. These results suggest SCR as a more effective treatment option than RSA for irreparable MRCT in this population.

Level of evidence

Level III, Retrospective comparative study.