PMID- 34778478
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220428
IS  - 2325-9671 (Print)
IS  - 2325-9671 (Electronic)
IS  - 2325-9671 (Linking)
VI  - 9
IP  - 11
DP  - 2021 Nov
TI  - Outcomes After Arthroscopic Rotator Cuff Repair Using Margin Convergence Versus 
      Superior Capsular Reconstruction: Should Candidates for Margin Convergence Be 
      Treated With Superior Capsular Reconstruction?
PG  - 23259671211050624
LID - 10.1177/23259671211050624 [doi]
LID - 23259671211050624
AB  - BACKGROUND: Both margin convergence rotator cuff repair (MC-RCR) and superior 
      capsular reconstruction (SCR) result in improved clinical outcomes in the 
      treatment of massive rotator cuff tears (RCTs). The question remains whether it 
      is better to perform MC-RCR using native, albeit occasionally deficient, tissues 
      or to perform primary SCR. PURPOSE/HYPOTHESIS: To compare the clinical results of 
      MC-RCR versus SCR for the treatment of massive RCTs. It was hypothesized that SCR 
      would yield better outcomes. STUDY DESIGN: Cohort study; Level of evidence, 3. 
      METHODS: Included were patients who underwent arthroscopic MC-RCR or SCR for 
      massive RCTs performed by a single surgeon between 2014 and 2019. MC-RCR was 
      performed if it was technically possible to close the defect; otherwise, SCR was 
      performed. Outcomes were assessed at 6 months and then annually using American 
      Shoulder and Elbow Surgeons; Single Assessment Numerical Evaluation; shortened 
      version of Disabilities of the Arm, Shoulder and Hand; 12-Item Short Form Health 
      Survey Physical Component Summary; and patient satisfaction scores. The minimal 
      clinically important difference (MCID), substantial clinical benefit (SCB), and 
      Patient Acceptable Symptom State (PASS) were compared between groups. Revision 
      surgeries and complications were reported. RESULTS: Included were 46 patients in 
      the MC-RCR group (mean age, 59 +/- 8 years) and 46 patients in the SCR group (mean 
      age, 57 +/- 7 years); 29 patients in each group were available at 2-year follow-up. 
      Preoperative outcome scores were not significantly different between groups. 
      Within groups, all outcome scores improved from pre- to postoperatively (P < 
      .05), with no significant differences in postoperative scores or patient 
      satisfaction between groups. No significant between-group differences were noted 
      in the percentage of patients who reached the MCID, SCB, and PASS (MCID, 92.3% vs 
      84.6%; SCB, 80.8% vs 80.8%; and PASS, 66.7% vs 66.7%). SCR had a significantly 
      lower survivorship rate compared with MC-RCR (84.7% vs 100%) (P = .026). 
      CONCLUSION: Both MC-RCR and SCR provided similar improvement in outcomes; 
      however, SCR resulted in a significantly lower survivorship rate at 2 years 
      postoperatively. If an RCT is technically repairable, we recommend that it be 
      repaired primarily, even if MC techniques are needed to close the defect. SCR 
      remains a good option for massive RCTs that are not technically repairable.
CI  - (c) The Author(s) 2021.
FAU - Ciccotti, Michael
AU  - Ciccotti M
AD  - Steadman Philippon Research Institute, Vail, Colorado, USA.
AD  - The Steadman Clinic, Vail, Colorado, USA.
FAU - Horan, Marilee P
AU  - Horan MP
AD  - Steadman Philippon Research Institute, Vail, Colorado, USA.
FAU - Nolte, Philip-C
AU  - Nolte PC
AD  - Steadman Philippon Research Institute, Vail, Colorado, USA.
AD  - Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, 
      Ludwigshafen, Germany.
FAU - Elrick, Bryant P
AU  - Elrick BP
AD  - Steadman Philippon Research Institute, Vail, Colorado, USA.
FAU - Millett, Peter J
AU  - Millett PJ
AD  - The Steadman Clinic, Vail, Colorado, USA.
LA  - eng
PT  - Journal Article
DEP - 20211103
PL  - United States
TA  - Orthop J Sports Med
JT  - Orthopaedic journal of sports medicine
JID - 101620522
PMC - PMC8573497
OTO - NOTNLM
OT  - margin convergence
OT  - rotator cuff repair
OT  - rotator cuff tear
OT  - superior capsular reconstruction
COIS- One or more of the authors has declared the following potential conflict of 
      interest or source of funding: This work was partially funded directly by a grant 
      from Arthrex. M.C. has received education support from Liberty Surgical. 
      P.-C.N.'s position at the Steadman Philippon Research Institute was supported by 
      AGA, via Arthrex, for 1 calendar year. P.J.M. has received research support from 
      Arthrex, Ossur, Siemens, and Smith & Nephew; consulting fees from Arthrex; 
      royalties from Arthrex, Medbridge, and Springer; and hospitality payments from 
      Merz Pharmaceuticals, Arthrosurface, Stryker, and Sanofi-Aventis and has 
      stock/stock options in VuMedi. AOSSM checks author disclosures against the Open 
      Payments Database (OPD). AOSSM has not conducted an independent investigation on 
      the OPD and disclaims any liability or responsibility relating thereto.
EDAT- 2021/11/16 06:00
MHDA- 2021/11/16 06:01
PMCR- 2021/11/03
CRDT- 2021/11/15 07:10
PHST- 2021/06/14 00:00 [received]
PHST- 2021/06/29 00:00 [accepted]
PHST- 2021/11/15 07:10 [entrez]
PHST- 2021/11/16 06:00 [pubmed]
PHST- 2021/11/16 06:01 [medline]
PHST- 2021/11/03 00:00 [pmc-release]
AID - 10.1177_23259671211050624 [pii]
AID - 10.1177/23259671211050624 [doi]
PST - epublish
SO  - Orthop J Sports Med. 2021 Nov 3;9(11):23259671211050624. doi: 
      10.1177/23259671211050624. eCollection 2021 Nov.