Superior capsular reconstruction using a dermal allograft versus reverse total shoulder arthroplasty for the treatment of irreparable posterosuperior rotator cuff tears in patients aged <70 years: a comparative study with minimum 5-year follow-up
Background: Reverse total shoulder arthroplasty (RTSA) is the gold standard surgical procedure for irreparable posterosuperior rotator cuff tears. Superior capsular reconstruction (SCR) with acellular dermal allograft (DA) has demonstrated good short-term outcomes in younger patients. Studies that c...
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| Main Authors: | , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
February 2026
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| In: |
Orthopaedic journal of sports medicine
Year: 2026, Volume: 14, Issue: 2, Pages: 1-10 |
| ISSN: | 2325-9671 |
| DOI: | 10.1177/23259671251403024 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1177/23259671251403024
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| Author Notes: | Ayham Jaber, MD, Marilee P. Horan, MPH, Maximilian Hinz, MD, Christopher J. Hawryluk, MBS, Caleb S. Davis, MD, Bradley M. Kruckeberg, MD, Jason J. Long, MD, CAPT Matthew T. Provencher, MD, MBA MC USNR (Ret.), and Peter J. Millett, MD, MSc |
| Summary: | Background: Reverse total shoulder arthroplasty (RTSA) is the gold standard surgical procedure for irreparable posterosuperior rotator cuff tears. Superior capsular reconstruction (SCR) with acellular dermal allograft (DA) has demonstrated good short-term outcomes in younger patients. Studies that compare the 2 procedures are lacking. - Purpose/Hypothesis: The purpose of the study was to compare the outcomes of these 2 surgical techniques at a minimum 5-year follow-up to evaluate their efficacy, durability, and complication profiles. It was hypothesized that RTSA would result in superior outcome scores and higher survival rates. - Study Design: Cohort study; Level of evidence, 3. - Methods: This study retrospectively analyzed data from 69 consecutive patients <70 years of age who underwent either SCR with DA (n = 34) or RTSA (n = 35) for isolated irreparable posterosuperior rotator cuff tears without advanced osteoarthritis, with a minimum follow-up of 5 years. Failure was defined as revision surgery or clinical failure. Complications were reported. Kaplan-Meier survivorship analysis was performed. Patient demographics and pre- and postoperative patient-reported outcome measures (PROMs), including the American Shoulder and Elbow Surgeons (ASES) Score, Single Assessment Numerical Evaluation (SANE), the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the 12-item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS), satisfaction, and sports participation were assessed and compared between groups. - Results: Eleven patients in the SCR group (32.4%) and 3 patients in the RTSA group (8.6%) experienced failure. The RTSA group had superior survivorship (90.1%) at 5 years compared with the SCR group (75.0%) (P = .018). Follow-up of the remaining patients was achieved in 91.3% (21/23) in the SCR group and 81.3% (26/32) in the RTSA group, with significantly different mean follow-up durations (RTSA, 9.5 ± 2.4 [range, 5.0-16.3] years; SCR: 6.7 ± 1.4 [range, 5.0-9.0] years; P < .001). The respective mean ages at the time of surgery differed significantly (RTSA, 63.3 ± 4.8 [range, 46.1-70] years; SCR, 56.5 ± 6.7 [range, 41.2-67.2] years; P < .001). Aside from failures, no complications were reported in either surgical group. Preoperative PROMs were similar between groups (all P > .05). At follow-up, all PROMs in both treatment groups improved significantly from preoperative values (P < .001). When comparing postoperative PROMs between groups, ASES score, SANE, and SF-12 MCS did not significantly differ between groups (all P > .05). QuickDASH (RTSA, 24.3 ± 19.5; SCR, 11.3 ± 12.0; P = .009) and SF-12 PCS (RTSA, 44.3 ± 12.2; SCR, 52.1 ± 7.8; P = .016) did differ significantly, favoring SCR. Sports participation was moderately below the preinjury level in both groups (RTSA, <25% to 50%-65%; SCR, 25%-49% to 75%-99%) but improved significantly only in the SCR group (P = .009). Satisfaction was similar in both groups, with a median of 9 (range, 1-10). - Conclusion: In treating irreparable posterosuperior rotator cuff tears in younger patients, RTSA demonstrated superior survivorship (90.1%) compared with SCR with DA (75.0%) at mid-term follow-up. However, in patients without treatment failure, both RTSA and SCR had equal improvements in most PROMs at ≥5 years of follow-up, with some scores favoring SCR in nonfailure cases. Higher sports participation, PCS, and lower disability were noted in the SCR group. |
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| Item Description: | Online veröffentlicht: 20. Februar 2026 Gesehen am 20.03.2026 |
| Physical Description: | Online Resource |
| ISSN: | 2325-9671 |
| DOI: | 10.1177/23259671251403024 |