Arthroscopic superior capsule reconstruction augmentation using a semitendinosus autograft in massive reparable rotator cuff tears

Abstract

Background: Arthroscopic superior capsule reconstruction (SCR) augmentation is a viable treatment option for massive reparable cuff tears. This study aimed to retrospectively compare clinical and imaging outcomes of patients with reparable massive rotator cuff tears after arthroscopic rotator cuff repair (ARCR) with those after SCR augmentation using a semitendinosus autograft.

Methods: We retrospectively compared 50 patients with massive reparable rotator cuff tears who underwent ARCR and SCR augmentation (n = 25 each). Patients were clinically followed up for at least 2 years, and the American Shoulder and Elbow index, other patient-reported outcomes, active range of motion, and radiography and magnetic resonance imaging findings were assessed.

Results: At the final follow-up, both patient groups showed significant improvements in forward elevation in range of motion and visual analog scale scores. Improvements in the American Shoulder and Elbow scores in the SCR augmentation group were significantly superior to those in the ARCR group (48.3 and 28.9, P < .01). There was a significant difference in the retear rate between the SCR augmentation group and ARCR group (20% and 56%, respectively; P = .009).

Conclusion: Our study demonstrated that patient-reported outcomes and retear rates in patients who underwent SCR augmentation with rotator cuff repair for massive rotator cuff tears significantly improved compared with those in patients who underwent ARCR without augmentation. Augmentation with semitendinosus autografting during rotator cuff repair represents a solution for patients with massive reparable rotator cuff tears.

Keywords: Augmentation; Rotator cuff; Rotator cuff repair; Semitendinosus tendon; Shoulder; Superior capsule reconstruction.

Figure 1

Arthroscopic findings of the right posterolateral subacromial viewing portal. (A) Torn edge of the long head of the biceps tendon. (B) After identifying the comma sign (▴) and placing a traction stich, anterior interval slide and subscapularis tendon repair are performed. (C-F) The quality, stiffness, and retraction of the SSP, ISP, and SSC tendon are evaluated. Double traction sutures are prepared, and posterior interval sliding is performed along the lateral margin of the rotator cuff tendon directing the incision toward the base of the scapular spine. BT, biceps tendon; SSC, subscapularis tendon; SSP, supraspinatus tendon; ISP, infraspinatus tendon; G, glenoid; H, humerus.

Figure 2

Arthroscopic findings of the right posterolateral subacromial viewing portal. (A) Graft preparation using the semitendinosus tendon. The tendon stump is tied in a whip-stitched fashion with a pull-out suture string. (B) Then, the graft (⇑) is shuttled from the lateral anchor portal to the anterosuperior portal using a flexible cannula. (C) The anterior graft (+) is fixed at the anterosuperior glenoid using a glenoid anchor. (D) Then, the graft tendon (+) is inserted into the socket at the greater tuberosity and immobilized using the tenodesis technique with bioabsorbable interference screw fixation in 30°-45° of abduction and 30° of external rotation. (E) The posterior graft (∗) is fixed at the posterosuperior glenoid using a glenoid anchor. (F) The posterior graft (∗) is fixed at the greater tuberosity in the same manner. (G) The grafts are placed anteriorly (+) and posteriorly (∗) for reinforcement of the rotator cuff. (H) Finally, a partial repair of the remaining rotator cuff over the top of the graft is performed. SSP, supraspinatus tendon; ISP, infraspinatus tendon; GL, glenoid; HH, humeral head.

Figure 3

Arthroscopic findings of the right posterolateral subacromial viewing portal. (A) Identification of the intact long head of the biceps tendon (BT) and massive cuff tear. (B) The BT and semitendinosus tendon (∗) are used for reinforcement of the rotator cuff. (C) Repair of the remaining rotator cuff over the top of the graft is performed. SSP, supraspinatus tendon; ISP, infraspinatus tendon; G, glenoid; BT, biceps tendon; H, humerus

Figure 4

Patient flowchart. The tear size of the rotator cuff is identified using the Collin and Patte classification systems. ARCR, arthroscopic rotator cuff repair; SCR, superior capsule reconstruction.