Comparison of the clinical outcomes and temporal changes between superior capsular reconstruction and reverse total shoulder arthroplasty in patients with irreparable rotator cuff tear without osteoarthritic change.

Abstract

Superior capsular reconstruction (SCR) and reverse total shoulder arthroplasty (rTSA) are widely performed in patients with irreparable rotator cuff tears, including pseudoparalytic shoulder (PPS), and have shown positive clinical outcomes. However, limited studies have compared these 2 in terms of functional recovery in patients with PPS without osteoarthritic change. Thus, this study aimed to compare the clinical outcomes and to clarify the characteristics and differences in temporal changes among patients who underwent either rTSA or SCR using tensor fascia lata for PPS due to irreparable rotator cuff tear without osteoarthritic change (Hamada grade ≤3). We enrolled a total of 39 patients who underwent SCR (n = 20) or rTSA (n = 19 cases) with a follow-up period of 2 years. All patients were followed up at 2, 3, 4, 5, 6, 8, 10, 12, and 24 months postoperatively. Preoperative and postoperative range of motion (ROM), American Shoulder and Elbow Surgeons scores, and temporal changes in ROMs were compared between the 2 groups. The SCR group had significantly better ROM than the rTSA group in flexion (146° ± 34° vs. 132° ± 23°, P = .022), abduction (147° ± 36° vs. 130° ± 23°, P = .0092), internal rotation (11 ± 3 Th10 vs. 6 ± 3 L3, P < .001), and American Shoulder and Elbow Surgeons score (84.1 ± 13.8 vs. 80.1 ± 6.1, P = .0096). While the rTSA group achieved 100° in flexion and abduction after 3 months postoperatively, the SCR group took approximately 5 months. However, the SCR group exceeded the rTSA group in flexion and abduction at six months postoperatively. In the SCR group, some patients with irreparable subscapularis tendon tears could not achieve 90° shoulder elevation. Both groups showed significant improvements in shoulder flexion and abduction compared to the preoperative state (P < .001). Although SCR requires a longer rehabilitation period, it provides similar outcomes to rTSA after two years for nonosteoarthritic, irreparable cuff tears with pseudoparalysis.