Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

摘要

Objectives: An arthroscopic superior capsule reconstruction, in which the fascia lata autograft attached medially to the superior glenoid and laterally to the greater tuberosity, restores shoulder stability and muscle balance in patients with irreparable rotator cuff tears; consequently, it improves shoulder function specifically deltoid muscle function and relieves pain. We assessed the clinical outcome of arthroscopic superior capsule reconstruction (Figure 1) in 100 consecutive patients with irreparable rotator cuff tears. Specifically, we focused on the rates of return to sport and work. Methods: From 2007 to 2014, we performed arthroscopic superior capsule reconstruction on 107 consecutive patients (mean 66.7 years; range, 43 to 82) with irreparable rotator cuff tears that had failed conservative treatment. Seven patients were lost to follow-up because of other medical problems or reasons. In the remaining 100 patients there were 56 supraspinatus and infraspinatus tears; 39 supraspinatus, infraspinatus, and subscapularis tears; 3 supraspinatus, infraspinatus, teres minor, and subscapularis tears; and 2 supraspinatus, infraspinatus, and teres minor tears. Physical examination, radiography, and MRI were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. Rates of return to sport and work were also investigated in those patients who had been employed (34 patients: 21 manual workers, 10 farmers, 1 butcher, 1 cook, and 1 athletic trainer) or played sport (26 patients: 6 golf, 4 table tennis, 4 swimming, 3 martial arts, 2 baseball, 2 yoga, 1 tennis, 1 badminton, 1 skiing, 1 mountain-climbing, and 1 ground golf) before injury. Results: The average preoperative American Shoulder and Elbow Surgeons (ASES) score was 31.6 points (range, 3.3 to 63.3 points) and the average Japanese Orthopaedic Association (JOA) score was 51.6 points (26.5 to 68.5 points). Average postoperative clinical outcome scores all improved significantly at final follow-up (mean, 36.6 months after surgery; range, 12 to 96 months; ASES, 93.3 points; JOA, 92.2 points) (P < .00001). Ninety-two patients (92%) had neither graft tear nor re-tear of the repaired rotator cuff tendon during the follow-up period (5 to 8 years of follow-up, 17 patients; 3 to 4 years of follow-up, 19 patients; 1 to 2 years of follow-up, 56 patients). Postoperative clinical outcome scores and active elevation at final follow-up were significantly better in healed patients (ASES, 95.5 points; JOA, 93.7 points, 154.8° ± 24.2°) than in unhealed patients suffering from graft tear or re-tear of the repaired rotator cuff tendon (ASES, 76.3 points, P < 0.0001; JOA, 79.5, P < 0.001; 115.0° ± 41.8°, P < 0.001). Thirty-two patients returned fully to their previous jobs, whereas two patients returned with reduced hours and workloads. All 26 patients who had played sport before their injuries returned fully to their previous sports, although most of the patients had been playing at recreational level before their injuries. Conclusion: Arthroscopic superior capsule reconstruction restored shoulder function and resulted in high rates of return to recreational sport and work. Graft tear or re-tear of the repaired rotator cuff tendon exacerbated the clinical outcome after superior capsule reconstruction. These results suggest that arthroscopic superior capsule reconstruction is a viable surgical option for irreparable rotator cuff tears, especially in patients who work and enjoy sport.