Margin convergence versus superior capsular reconstruction for massive irreparable rotator cuff tears: outcomes are equivalent unless there is pre-operative pseudoparesis.

BACKGROUND: Margin convergence (MC) and superior capsular reconstruction (SCR) are common treatment options for irreparable rotator cuff tears in younger patients, although they differ in associated costs and operative times. The purpose of this study was to compare range of motion, patient reported outcomes (PROs), and re-operation rates following MC and SCR. We hypothesized superior outcomes after SCR relative to MC regarding functional outcomes, subjective measures, and re-operation rates.

METHODS: This was a multicenter retrospective review of 59 patients from three surgeons treating irreparable rotator cuff tears with either MC (n=28) or SCR (n=31) and minimum 1-year follow-up from 2014-2019. Visual Analogue Scale (VAS) for pain, Subjective Shoulder Value (SSV), active forward flexion (FF), external rotation (ER), re-tear rate, and conversion rate to reverse shoulder arthroplasty were evaluated. T-tests and Chi-Squared tests were used for continuous and categorical variables, respectively (*p<0.05).

RESULTS: Baseline demographics, range of motion, and MRI findings were similar between groups. Average follow-up was 31.5 months and 17.8 months for MC and SCR groups (p<0.001). The MC and SCR groups had similar postoperative FF (151 ± 26 vs 142 ± 38 degrees; p=0.325) and ER (48 ± 12 vs 46 ± 11 degrees; p=0.284), with both groups not improving significantly from their preoperative baselines. However, both cohorts demonstrated significant improvements in VAS (MC: 7.3 to 2.5; SCR: 6.4 to 1.0) and SSV (MC: 54% to 82%; SCR: 38% to 87%). There were no significant differences in postoperative VAS, SSV, and rates of re-tear or rates of conversion to arthroplasty between groups. In patients with preoperative pseudoparesis (FF < 90°), SCR (n=9) resulted in greater postoperative FF than MC (n=5) (141 ± 38 vs 67 ± 24 degrees; p=0.002).

CONCLUSION: Both MC and SCR demonstrated excellent postoperative outcomes in the setting of massive irreparable rotator cuff tear, with significant improvements in PROs and no significant differences in range of motion. Specifically for patients with preoperative pseudoparesis, SCR was more effective in restoring forward elevation. Further long-term studies are needed to compare outcomes and establish appropriate indications.