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

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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.

Summary

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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kovacevic D, Suriani RJ Jr, Grawe BM, Yian EH, Gilotra MN, Hasan SA, et al. Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response. J Shoulder Elbow Surg. 2020;29:2459–75.

    Article  PubMed  PubMed Central  Google Scholar 

  2. • Dey Hazra ME, Dey Hazra R-O, Hanson JA, Ganokroj P, Vopat ML, Rutledge JC, et al. Treatment options for massive irreparable rotator cuff tears: a review of arthroscopic surgical options. EFORT Open Rev. 2023;8:35–44. An updated comprehensive review of all avalible treatment options for massive irreparable rotator cuff tears.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kucirek NK, Hung NJ, Wong SE. Treatment options for massive irreparable rotator cuff tears. Curr Rev Musculoskelet Med. 2021;14:304–15.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Burkhart SS, Denard PJ, Adams CR, Brady PC, Hartzler RU. Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff repair. Arthrosc Tech. 2016;5:e1407–18.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tokish JM, Makovicka JL. The Superior capsular reconstruction: lessons learned and future directions. J Am Acad Orthop Surg. 2020;28:528–37.

    Article  PubMed  Google Scholar 

  6. Noyes MP, Haidamous G, Spittle NE, Hartzler RU, Denard PJ. Surgical management of massive irreparable cuff tears: superior capsular reconstruction. Curr Rev Musculoskelet Med. 2020;13:717–24.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wang Y, Ding W, Xu J, Ruan D, Heng BC, Ding Q, et al. Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff tears results in significant improvements in patient reported outcomes and range of motion: a systematic review. ASMAR. 2022;4:e1523–37.

    PubMed  PubMed Central  Google Scholar 

  8. Werthel J-D, Vigan M, Schoch B, Francophone Arthroscopy Society (SFA), Lädermann A, Nourissat G, et al. Superior capsular reconstruction - a systematic review and meta-analysis. Orthop Traumatol Surg Res. 2021;107(8S):103072.

  9. Goetti P, Denard PJ, Collin P, Ibrahim M, Hoffmeyer P, Lädermann A. Shoulder biomechanics in normal and selected pathological conditions. EFORT Open Rev. 2020;5:508–18.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Huri G, Kaymakoglu M, Garbis N. Rotator cable and rotator interval: anatomy, biomechanics and clinical importance. EFORT Open Rev. 2019;4:56–62.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Arai R, Matsuda S. Macroscopic and microscopic anatomy of the rotator cable in the shoulder. J Orthop Sci. 2020;25:229–34.

    Article  PubMed  Google Scholar 

  12. Denard PJ, Koo SS, Murena L, Burkhart SS. Pseudoparalysis: the importance of rotator cable integrity. Orthopedics. 2012;35:e1353–7.

    Article  PubMed  Google Scholar 

  13. Adams CR, Pasqualini I, Heidenthal JM, Brady PC, Denard PJ. A technique for a suture-based cable reconstruction of an irreparable posterosuperior rotator cuff tear. Arthrosc Tech. 2022;11:e2055–60.

    Article  PubMed  PubMed Central  Google Scholar 

  14. •• Callegari JJ, Phillips CJ, Lee TQ, Kruse K, Denard PJ. Semitendinosus allograft cable reconstruction technique for massive irreparable rotator cuff tears. Arthrosc Tech. 2022;11:e153–61. A novel surgical technique for addressing massive irreparable rotator cuff tears that offers a promising alternative for managing these challenging cases.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med. 2012;40:2248–55.

    Article  PubMed  Google Scholar 

  16. Ishihara Y, Mihata T, Tamboli M, Nguyen L, Park KJ, McGarry MH, et al. Role of the superior shoulder capsule in passive stability of the glenohumeral joint. J Shoulder Elbow Surg. 2014;23:642–8.

    Article  PubMed  Google Scholar 

  17. Ciampi P, Scotti C, Nonis A, Vitali M, Di Serio C, Peretti GM, et al. The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study. Am J Sports Med. 2014;42:1169–75.

    Article  PubMed  Google Scholar 

  18. Mihata T, Bui CNH, Akeda M, Cavagnaro MA, Kuenzler M, Peterson AB, et al. A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear. J Shoulder Elbow Surg. 2017;26:2158–66.

    Article  PubMed  Google Scholar 

  19. Zhao X, Jia J, Wen L, Zhang B. Biomechanical outcomes of superior capsular reconstruction for irreparable rotator cuff tears by different graft materials-a systematic review and meta-analysis. Front Surg. 2022;9: 939096.

    Article  PubMed  Google Scholar 

  20. E Cline K, Tibone JE, Ihn H, Akeda M, Kim BS, McGarry MH, et al. Superior capsule reconstruction using fascia lata allograft compared with double- and single-layer dermal allograft: a biomechanical study. Arthroscopy. 2021;37(4):1117–25.

  21. Sutter EG, Godin JA, Garrigues GE. All-arthroscopic superior shoulder capsule reconstruction with partial rotator cuff repair. Orthopedics. 2017;40:e735–8.

    Article  PubMed  Google Scholar 

  22. Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29:459–70.

    Article  PubMed  Google Scholar 

  23. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ. Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears. Arthroscopy. 2016;32:418–26.

    Article  PubMed  Google Scholar 

  24. Lacheta L, Brady A, Rosenberg SI, Dekker TJ, Kashyap R, Zandiyeh P, et al. Superior capsule reconstruction with a 3 mm-thick dermal allograft partially restores glenohumeral stability in massive posterosuperior rotator cuff deficiency: a dynamic robotic shoulder model. Am J Sports Med. 2021;49:2056–63.

    Article  PubMed  Google Scholar 

  25. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ. Biomechanical effects of acromioplasty on superior capsule reconstruction for irreparable supraspinatus tendon tears. Am J Sports Med. 2016;44:191–7.

    Article  PubMed  Google Scholar 

  26. Denard PJ, Chae S, Chalmers C, Choi JH, McGarry MH, Adamson G, et al. Biceps box configuration for superior capsule reconstruction of the glenohumeral joint decreases superior translation but not to native levels in a biomechanical study. Sports Med Arthrosc Rehabil Ther Technol. 2021;3:e343–50.

    Google Scholar 

  27. El-Shaar R, Soin S, Nicandri G, Maloney M, Voloshin I. Superior capsular reconstruction with a long head of the biceps tendon autograft: a cadaveric study. Orthop J Sports Med. 2018;6:2325967118785365.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mihata T, Lee TQ, Hasegawa A, Kawakami T, Fukunishi K, Fujisawa Y, et al. Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears. Am J Sports Med. 2018;46:2707–16.

    Article  PubMed  Google Scholar 

  29. Mihata T, Lee TQ, Fukunishi K, Itami Y, Fujisawa Y, Kawakami T, et al. Return to Sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears. Am J Sports Med. 2018;46:1077–83.

    Article  PubMed  Google Scholar 

  30. Ângelo ACLPG, de Campos Azevedo CI. Donor-site morbidity after autologous fascia lata harvest for arthroscopic superior capsular reconstruction: a midterm follow-up evaluation. Orthop J Sports Med. 2022;10(2):23259671211073133.

  31. Ângelo ACLPG, de Campos Azevedo CI. Minimally invasive fascia lata harvesting in ASCR does not produce significant donor site morbidity. Knee Surg Sports Traumatol Arthrosc. 2019;27:245–50.

    Article  PubMed  Google Scholar 

  32. Kitridis D, Yiannakopoulos C, Sinopidis C, Givissis P, Galanis N. Superior capsular reconstruction of the shoulder using the long head of the biceps tendon: a systematic review of surgical techniques and clinical outcomes. Medicina. 2021;57:229.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cheppalli NS, Purudappa PP, Metikala S, Reddy KI, Singla A, Patel HA, et al. Superior capsular reconstruction using the biceps tendon in the treatment of irreparable massive rotator cuff tears improves patient-reported outcome scores: a systematic review. ASMAR. 2022;4:e1235–43.

    PubMed  PubMed Central  Google Scholar 

  34. Cheppalli NS, Purudappa PP, Metikala S, Goel A, Singla A, Sambandam S. Using biceps tendon autograft as a patch in the treatment of massive irreparable rotator cuff tears improves patient-reported outcome scores: a systematic review. ASMAR. 2023;5:e529–36.

    PubMed  PubMed Central  Google Scholar 

  35. Kocaoglu B, Firatli G, Ulku TK. Partial rotator cuff repair with superior capsular reconstruction using the biceps tendon is as effective as superior capsular reconstruction using a tensor fasciae latae autograft in the treatment of irreparable massive rotator cuff tears. Orthop J Sports Med. 2020;8:2325967120922526.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Denard PJ, Brady PC, Adams CR, Tokish JM, Burkhart SS. Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft. Arthroscopy. 2018;34:93–9.

    Article  PubMed  Google Scholar 

  37. Pennington WT, Bartz BA, Pauli JM, Walker CE, Schmidt W. Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: short-term clinical outcomes and the radiographic parameter of superior capsular distance. Arthroscopy. 2018;34:1764–73.

    Article  PubMed  Google Scholar 

  38. Burkhart SS, Hartzler RU. Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis. Arthroscopy. 2019;35:22–8.

    Article  PubMed  Google Scholar 

  39. Smith TJ, Gowd AK, Kunkel J, Kaplin L, Hubbard JB, Coates KE, et al. Clinical outcomes of superior capsular reconstruction for massive, irreparable rotator cuff tears: a systematic review comparing acellular dermal allograft and autograft fascia lata. Sports Med Arthrosc Rehabil Ther Technol. 2021;3:e257–68.

    Google Scholar 

  40. Makovicka JL, Patel KA, Tokish JM. Superior capsular reconstruction with the addition of an acromial acellular dermal allograft spacer. Arthrosc Tech. 2018;7:e1181–90.

    Article  PubMed  PubMed Central  Google Scholar 

  41. •• Tokish JM, Momaya A, Roberson T. Superior capsular reconstruction with a partial rotator cuff repair: a case report. JBJS Case Connect. 2018;8: e1. Introduces a potentially innovative and less invasive surgical approach for treating irreparable rotator cuff tears providing new insights and expanding treatment options for patients with challenging shoulder conditions, ultimately improving their outcomes.

    Article  PubMed  Google Scholar 

  42. Burkhart SS, Esch JC, Jolson RS. The rotator crescent and rotator cable: an anatomic description of the shoulder’s “suspension bridge.” Arthroscopy. 1993;9:611–6.

    Article  CAS  PubMed  Google Scholar 

  43. Denard PJ, Park MC, McGarry MH, Adamson G, Lee TQ. Biomechanical assessment of a V-shaped semitendinosus allograft anterior cable reconstruction for irreparable rotator cuff tears. Arthroscopy. 2022;38:719–28.

    Article  PubMed  Google Scholar 

  44. Park MC, Hung VT, DeGiacomo AF, McGarry MH, Adamson GJ, Lee TQ. Anterior Cable reconstruction of the superior capsule using semitendinosus allograft for large rotator cuff defects limits superior migration and subacromial contact without inhibiting range of motion: a biomechanical analysis. Arthroscopy. 2021;37:1400–10.

    Article  PubMed  Google Scholar 

  45. Park MC, Itami Y, Lin CC, Kantor A, McGarry MH, Park CJ, et al. Anterior Cable reconstruction using the proximal biceps tendon for large rotator cuff defects limits superior migration and subacromial contact without inhibiting range of motion: a biomechanical analysis. Arthroscopy. 2018;34:2590–600.

    Article  PubMed  Google Scholar 

  46. Seo J-B, Kwak K-Y, Park B, Yoo J-S. Anterior cable reconstruction using the proximal biceps tendon for reinforcement of arthroscopic rotator cuff repair prevent retear and increase acromiohumeral distance. J Orthop. 2021;23:246–9.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Yang H, Lee S, Shin S-J. Satisfactory functional and structural outcomes of anterior cable reconstruction using the proximal biceps tendon for large retracted rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2023;31:1910–8.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Ignacio Pasqualini

  2. Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA

    Joseph C. Brinkman & John M. Tokish

  3. Oregon Shoulder Institute, Medford, OR, USA

    Patrick J. Denard

Authors
  1. Ignacio Pasqualini
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  2. Joseph C. Brinkman
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  3. John M. Tokish
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  4. Patrick J. Denard
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Contributions

IP: initial writing, prepared figures and critical revisionsJB: initial writing and critical revisionsJT: Supervision, writing and critical draft revisions, conceptualizationPD: Supervision, writing and critical draft revisions, conceptualization

Corresponding author

Correspondence to Patrick J. Denard.

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Conflict of Interest

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.

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Pasqualini, I., Brinkman, J.C., Tokish, J.M. et al. Surgical Management of Massive Irreparable Cuff Tears: Superior Capsule Reconstruction and Rotator Cable Reconstruction. Curr Rev Musculoskelet Med 17, 101–109 (2024). https://doi.org/10.1007/s12178-024-09887-x

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