PURPOSE: To evaluate surgical techniques and clinical outcomes for arthroscopic superior capsular reconstruction (SCR) for treatment of massive irreparable rotator cuff tears.METHODS: A systematic review was registered with PROSPERO and performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane databases were searched. Studies investigating SCR with reported surgical technique were included. Animal studies, cadaveric studies, review studies, and letters to the editor were excluded. Technical aspects of surgical technique for SCR were analyzed in each article, which included: graft type, glenoid fixation method, greater tuberosity fixation method, graft passage technique, suture management, margin convergence, concomitant procedures, and post-operative rehabilitation protocol. Clinical outcomes, when available, were also analyzed.RESULTS: Three hundred sixty-five articles were screened with 29 found that described surgical technique for SCR. According to the Modified Coleman Methodology Score, 24 articles were poor (scores <55), 4 were fair (scores between 55 and 69), and 1 was good (scores between 70 and 84) with an average score of 25.8 ± 20.9. The most commonly used technique for SCR utilized: acellular dermal allograft, two biocomposite suture anchors for glenoid fixation, transosseus equivalent double-row suture anchor fixation for greater tuberosity fixation with two biocomposite medial row anchors and two biocomposite lateral row anchors, double-pulley technique combined with an arthroscopic grasper and/or pull suture to pass the graft into the shoulder, performance of both anterior and posterior margin convergence, and native rotator cuff repair when possible. Only 8 of the studies reported clinical outcomes, and they showed that SCR provides significant improvement in patient-reported outcomes, significant improvement in shoulder ROM, variable graft failure rates, low complication rates, and variable reoperation rates. There were no studies comparing outcomes between the various surgical techniques.CONCLUSIONS: Many surgical techniques exist for arthroscopic SCR. However, no superior technique was demonstrated, as there were no studies comparing clinical outcomes among these various techniques.
View details for DOI 10.1016/j.arthro.2020.09.016
View details for PubMedID 33227320