Highlights
- •Failure of the SCR was evident on imaging in 10 of 11 of the symptomatic subjects.
- •There was an overall SCR graft failure rate of 14% over the study period.
- •Three distinct modes of failure were identified on MRI:
- (1)midsubstance rupture of the graft;
- (2)loss of both humeral and glenoid fixation; and
- (3)loss of glenoid fixation with intact graft.
- (1)
Abstract
Background
Superior capsular reconstruction (SCR) of the shoulder is an increasingly common procedure
in the treatment of patients with massive, irreparable rotator cuff tears lacking
significant osteoarthritis. Post-operatively, the appearance of failed grafts has
only been described in isolated case reports and review articles.
Methods
From January 2016 through December 2017, surgical records at a single tertiary-care
facility were queried to identify all patients undergoing SCR. Patient records were
reviewed for patient demographic information, reason for post-operative MRI, and post-operative
surgeon assessment. 74 patients underwent SCR, of whom 12 received a follow-up MRI
post-operatively. One patient was excluded due to missing records; the remaining 11
patients comprise the study cohort. Post-operative MRIs were obtained at mean six
months after surgery.
Results
On review of post-operative MRIs, three distinct locations of failure were identified.
Four patients (40%) had midsubstance failure of the allograft with all glenoid and
humeral head fixation remaining intact. One patient (10%) had complete detachment
of the allograft from both glenoid and humeral head fixation. Five patients (50%)
had detachment of the allograft from the glenoid.
Conclusion
In this series of ten failed SCRs, the most common mode of failure was loss of fixation
on the glenoid, followed closely by midsubstance rupture. We found no instances of
isolated fixation failure on the humeral head. This series illustrates the need for
careful imaging in patients whose post-operative course suggests clinical failure.
These findings suggest that strengthening glenoid fixation may provide better clinical
outcomes as this procedure becomes more common.
Level of evidence: III - Retrospective study.
Keywords
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Article info
Publication history
Published online: November 13, 2019
Accepted:
October 11,
2019
Received in revised form:
July 28,
2019
Received:
March 14,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
