Patients Can Return to Work and Sports 5 Years after Superior Capsule Reconstruction
The arthroscopic superior capsule reconstruction (SCR) surgical technique is intended as an option for restoring superior shoulder stability, muscle balance, and shoulder function in patients with irreparable rotator cuff tears.
Teruhisa Mihata, MD, PhD, from Osaka Medical College in Osaka, Japan, and his colleagues developed the technique, and at the 2019 AOSSM/AANA Specialty Day, they reported on patient outcomes up to 5 years after surgery, building on earlier research that examined short-term patient results. Their objectives were to evaluate:
- Changes in functional outcome
- Changes in graft thickness
- Rates of graft tear
- Rates of glenohumeral osteoarthritis
They found that SCR offers patients not only restored shoulder function, but also the opportunity to return to sports and physically demanding work.
“We studied 30 patients who were treated with arthroscopic SCR and consistently saw improvements in outcomes related to shoulder function and the daily lives of those treated,” Dr. Mihata said. “The technique allowed 11 of 12 patients who had previously worked to return full-time at 5-year follow-up, and all 8 who had participated in sports to return to play.”
Dr. Mihata and his colleagues had performed SCR on 37 shoulders between 2007 and 2013. They included 30 shoulders in the study, as 7 shoulders were lost to follow-up. The researchers evaluated:
- Shoulder range of motion (ROM)
- American Shoulder and Elbow Surgeons (ASES) score
- Japanese Orthopaedic Association (JOA) score
- Acromiohumeral distance (AHD)
- Hamada grade
- Goutallier grade
All measures were assessed before surgery and at 1 year and 5 years after surgery.
ASES and JOA scores improved significantly at 1 year and 5 years after surgery. The average ASES scores rose from 29.0 before surgery to 83.0 at 1 year and 92.3 at 5 years after surgery, with JOA scores rising from 51.5 before surgery to 85.9 and 91.4, respectively.
Active elevation increased from 85° prior to surgery to 151° 5 years after the operation. Hamda grade and AHD also improved significantly at 1 and 5 years after SCR (P< 0.001 for both). None of the patients experienced a significant change in the Goutallier grade after surgery.
Of the 30 patients followed for 5 years, only 3 (10%) experienced graft tears. Those who demonstrated graft healing – measured by MRI at 3 months, 1 year, and 5 years after surgery – also showed no sign of glenohumeral osteoarthritis during the 5-year period, while 2 of the 3 patients with graft tears had severe glenohumeral osteoarthritis.
“Our latest research shows continued promise for the arthroscopic SCR technique, particularly to restore a patient’s shoulder function and allow them to return to work or sports if they so choose,” Dr. Mihata said. “We plan to continue studying longer-term outcomes for patients, focusing on continued function and the appearance of osteoarthritis.”
Mihata T. Lee TQ, Hasegawa A, Fukunishi K, Kawakami T, Fujisawa Y, Itami Y, Ohue M, Neo M. Five-year Follow-up of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears (Paper 04). Presented at the 2019 AOSSM/AANA Specialty Day, March 16, Las Vegas, Nevada.