The Outcomes Of Arthroscopic Superior Capsule Reconstruction For Irreparable Rotator Cuff Tears

Objective: Superior capsule reconstruction(SCR)is widely used in treating irreparable rotator cuff tear(IRCT)with early curative effect.However,the long head of the biceps tendon(LHBT)in the SCR is unclear.The SCR does not make use of the biological and mechanical properties of LHBT.The study compares the outcomes in IRCT patients with different methods of LHBT in the SCR to explore the role of LHBT in SCR and the importance of Traditional Chinese Medicine(TCM)rehabilitation,providing some references and theoretical basis for the formulation of the operative plan.Methods: From January 2018 to December 2019,data of 30 IRCT patients under SCR at the Affiliated Hospital of the Traditional Chinese Medicine of Southwest Medical University were retrospectively analyzed.Based on the quality of LHBT,the complementary treatments were carried out,dividing into two groups: the TTO group(15)and the TTR group(15).TTO group: Based on SCR,the LHBT is tenotomized and sutured with or without anchors into the intertubercular groove laterally,whereas medially,it is removed at the glenoid labrum.TTR group: Based on SCR,do not tenotomize the LHBT,keeping its integrity and continuity,transfer it to the footprint of the greater tuberosity.Autologous fascia lata of the ipsilateral thigh was used as a graft in both groups.The MRI evaluation of IRCT: IRCT is defined as defects measuring >5cm or involving two or more torn tendons with tears retracted to the glenoid(Patte 2-3)and fatty infiltration of supraspinatus(Goutallier 3-4).Gold standard: IRCT with severely retracted supraspinatus,which was intraoperatively reducible with excessive tension or irreducible.Fixed with an abduction pillow after the reconstruction.The individual TCM rehabilitation exercises under the guidance of the physical therapist.Parameters: The pre-and post-operative shoulder active range of motion(ROM),Constant-Murley score(CMS),American shoulder and elbow surgeons(ASES),University of California Los Angeles(UCLA),and Visual analog scale(VAS)scores.The integrity was evaluated according to the MRI and complications during follow-up.Results: Compared with pre-operative ROM,functional scores,and VAS scores,all patients showed statistical improvement with TTO,TTR groups at the final follow-up(P<0.05).Compared with pre-operative ROM of both groups,there was no statistical significance between pre-and post-operative three months(P>0.05),while there were significances in six,twelve months,and the final follow-up postoperatively(P<0.05).Compared with pre-operation,there were no statistically differences in ROM,ASES,UCLA,and VAS scores between TTO and TTR groups at postoperative three,six,twelve months,and the final followup(P>0.05),while there is a statistical difference in CMS score between TTR and TTO group at the final follow-up(P<0.05).At the final follow-up,there was a case that occurred looseness of the anchor in the TTR group,while there was a case that occurred great tuberosity resorption and a case donor complication(chronic pain)in the TTO group.There were no other complications,such as retear.Conclusions:(1)Whether performed TTO or TTR of LHBT,combined with systematic TCM rehabilitation,SCR can relieve pain,restore the glenohumeral joint’s superior stability,and improve the shoulder joint’s ROM for IRCT patients.(2)The TTR group’s CMS score was higher than that of the TTO group,while there were no statistical differences in ASES,UCLA,VAS scores,and ROM.(3)SCR combined with TTR,to some extent,could enhance fixed strength,decrease the re-tear risks,and do not induce pain originated by LHBT.