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Review
. 2024 Apr;17(4):101-109.
doi: 10.1007/s12178-024-09887-x. Epub 2024 Feb 10.

Surgical Management of Massive Irreparable Cuff Tears: Superior Capsule Reconstruction and Rotator Cable Reconstruction

Ignacio Pasqualini  1 , Joseph C Brinkman  2 , John M Tokish  2 , Patrick J Denard  3
Affiliations
Review

Surgical Management of Massive Irreparable Cuff Tears: Superior Capsule Reconstruction and Rotator Cable Reconstruction

Ignacio Pasqualini et al. Curr Rev Musculoskelet Med. 2024 Apr.

Abstract

Purpose of review: Massive irreparable rotator cuff tears (MIRCTs) present treatment challenges. Recently, superior capsule reconstruction (SCR) and anterior cable reconstruction have emerged as surgical options, but no single approach is superior. This review provides an overview of SCR and cable reconstruction techniques, including biomechanical studies, clinical outcomes, and surgical considerations.

Recent findings: Biomechanical studies show SCR with autografts or allografts improves glenohumeral stability and mechanics. Clinical outcomes of SCR demonstrate improved range of motion, function scores, and pain relief in short-term studies. Anterior cable reconstruction reduces superior humeral head translation and subacromial pressures in biomechanical models. Early clinical studies report improved rotator cuff healing and outcomes for cable reconstruction in specific irreparable tear patterns. SCR and cable reconstruction are viable surgical options for MIRCTs based on early encouraging results. However, higher-level comparative studies with long-term follow-up are still needed. Careful consideration of tear pattern, patient factors, and surgical goals is required to optimize treatment of MIRCTs. Further research is necessary to determine the optimal role for these procedures.

Keywords: Biomechanics; Cable reconstruction; Clinical outcomes; Massive irreparable rotator cuff tears; Superior capsule reconstruction.

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Conflict of interest statement

Dr. Denard has the following conflicts of interest: American Shoulder and Elbow Surgeons; board or committee member of Arthrex, Inc.; IP royalties; paid consultant; paid presenter or speaker; research support of Arthroscopy Association of North America; board or committee member of Kaliber Labs; Orthopedics Today; editorial or governing board of PT Genie; and Stock or stock Options. Dr. Tokish has the following conflicts of interest: Arthrex, Inc.; IP royalties; paid consultant; paid presenter or speaker of Arthroscopy Association of North America; board or committee member of Journal of Shoulder and Elbow Surgery; editorial or governing board; publishing royalties and financial or material support of Orthopedics Today; and editorial or governing board.

Figures

Fig. 1
Fig. 1
Treatment algorithm for patients with MIRCT undergoing SCR
Fig. 2
Fig. 2
Treatment algorithm for patients with MIRCT undergoing cable reconstruction
Fig. 3
Fig. 3
Schematic view of the V-shaped graft secured to the glenoid with 2 knotless anchors. IS, infraspinatus; SSc, subscapularis
Fig. 4
Fig. 4
Schematic view of final cable allograft constructs viewed from topdown (A) and oblique (B) views. IS, infraspinatus; SSc, subscapularis
See this image and copyright information in PMC

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