Matthew A. Coker

Background: Irreparable Massive Rotator Cuff Tears (IMRCTs) pose a significant challenge due to insufficient tissue for full shoulder repair, leading to substantial glenohumeral instability. These tears predominantly affect the supraspinatus and infraspinatus muscles, more common in the elderly due to repetitive damage and in younger, active individuals due to acute injury.^1–3 Tissue compromise, marked by retraction, fatty infiltration, and atrophy, prevents complete reattachment, worsening joint instability.^4–7 Current treatments like partial rotator cuff repair (pRCR) and superior capsular reconstruction (SCR) aim to restore stability. However, gaps persist in evaluating their combined efficacy. This review assesses concomitant pRCR and SCR effectiveness in IMRCT patients.

Search Methods:  “Irreparable Massive Rotator Cuff Tear Treatment,” “Partial Rotator Cuff Repair,” and “Superior Capsular Reconstruction” were the search terms used to identify the results below.

Results: SCR and pRCR each demonstrated improvement in strength, range of motion, and pain in within-group comparisons individually.^8–10 Slightly improved strength in SCR was the only statistically significant difference between SCR and pRCR.⁹  Results yielded little data on concomitant usage. A comparison of SCR to concomitant SCR/pRCR shows superior improvement in pain and function in the concomitant group in the short term.¹¹ However, it is unclear as to whether this approach eliminates the risks of each procedure. For example, SCR has shown poorer outcomes in infection and retears with larger tears and poor graft quality.^9,12 While concomitant treatment improves IMRCT outcomes, there is limited data on how tear size, fat infiltration, graft quality, and atrophy impact subgroups of the concomitant approach. Further investigation is required to see if these concerns remain in the concomitant approach. Furthermore, SCR is still being modified as an individual procedure to improve graft quality.^13–15 As SCR adapts, further investigation should explore how improvements in SCR individually alter outcomes in a concomitant setting. Finally, more studies replicating the synergistic outcomes in concomitant usage are necessary to draw firm conclusions about added benefits and risks.

Conclusions: IMRCTs typically have poorer outcomes with standard treatment, but concomitant SCR/pRCR shows promise for IMRCTs, offering superior pain relief, function, and stability compared to SCR or pRCR alone. Despite demonstrating improvement, further investigation is warranted for subgroup and long-term outcomes as well as how clinical factors like tear severity and graft quality impact the concomitant use of SCR and pRCR.

Works Cited:

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2. Nyffeler RW, Schenk N, Bissig P. Can a simple fall cause a rotator cuff tear? Literature review and biomechanical considerations. Int Orthop. 2021;45(6):1573-1582. doi:10.1007/s00264-021-05012-6
3. Tan M, Lam PH, Le BTN, Murrell GAC. Trauma versus no trauma: an analysis of the effect of tear mechanism on tendon healing in 1300 consecutive patients after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2016;25(1):12-21. doi:10.1016/j.jse.2015.06.023
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5. Melis B, DeFranco MJ, Chuinard C, Walch G. Natural History of Fatty Infiltration and Atrophy of the Supraspinatus Muscle in Rotator Cuff Tears. Clin Orthop Relat Res. 2010;468(6):1498-1505. doi:10.1007/s11999-009-1207-x
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11. Woodmass JM, Wagner ER, Welp KM, et al. Partial Rotator Cuff Repair Provides Improved Patient-Reported Outcome Measures Following Superior Capsule Reconstruction (SCR). Arthrosc Sports Med Rehabil. 2022;4(4):e1261-e1268. doi:10.1016/j.asmr.2022.03.004
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13. Lee JB, Kholinne E, Yeom JW, et al. Effect of Fatty Infiltration of the Infraspinatus Muscle on Outcomes and Graft Failure After Arthroscopic Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears. Am J Sports Med. 2022;50(14):3907-3914. doi:10.1177/03635465221130459
14. Alike Y, Hou JY, Tang YY, et al. Arthroscopic Superior Capsule Reconstruction and Rotator Cuff Repair to Restore Static and Dynamic Stability of the Shoulder. Orthop Surg. 2020;12(5):1503-1510. doi:10.1111/os.12768
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