Improved Acromiohumeral Distance Independently Predicts Better Outcomes After Arthroscopic Superior Capsular Reconstruction Graft Tears

Hui Ben; Erica Kholinne; Jia Guo; Seung Min Ryu; Jian Loong Ling; Kyoung Hwan Koh; In-Ho Jeon

doi:10.1016/j.arthro.2024.08.017

Improved Acromiohumeral Distance Independently Predicts Better Outcomes After Arthroscopic Superior Capsular Reconstruction Graft Tears

Arthroscopy. 2024 Aug 28:S0749-8063(24)00616-9. doi: 10.1016/j.arthro.2024.08.017. Online ahead of print.

Authors

Hui Ben¹, Erica Kholinne², Jia Guo³, Seung Min Ryu³, Jian Loong Ling⁴, Kyoung Hwan Koh³, In-Ho Jeon⁵

Affiliations

¹ Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
² Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.
³ Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁴ Department of Orthopaedic Surgery, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia.
⁵ Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: jeonchoi@gmail.com.

PMID: 39214427
DOI: 10.1016/j.arthro.2024.08.017

Abstract

Purpose: To identify independent factors responsible for poor outcomes after a graft tear after arthroscopic superior capsular reconstruction (ASCR).

Methods: Patients who underwent ASCR for massive rotator cuff tears between January 2013 and July 2021were reviewed. On the basis of the achievement of the minimal clinically important differences for clinical outcome measures at the final follow-up, patients were divided into the good outcome (GO) and poor outcome (PO) groups. The minimal clinically important differences were calculated as the value equal to one-half of the standard deviation of the changes in outcome scores between the preoperative baseline and the latest follow-up. Pre- and final follow-up variables included demographics, American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, and range of motion. Preoperative and postoperative 1-year radiologic variables were analyzed using magnetic resonance imaging, including anteroposterior and mediolateral tear sizes, subscapularis tear, acromiohumeral distance (AHD), and degree of fatty degeneration. Logistic regression analysis was performed to identify the significant predictors of poor outcomes.

Results: A total of 33 patients who underwent ASCR presented with graft tears, which were confirmed by postoperative 1-year magnetic resonance imaging, and had a minimum follow-up duration of 2 years after surgery were enrolled. The GO group demonstrated significantly greater improvements in functional outcomes compared with the PO group (American Shoulder and Elbow Surgeons score: 83.5 ± 11.8 vs 64.0 ± 20.4, P = 0.004; Constant: 67.6 ± 5.7 vs 57.1 ± 9.8, P < .001; and visual analog scale score: 0.9 ± 1.2 vs 2.4 ± 2.0, P = .026). The postoperative 1-year AHD showed significant improvement in the GO group (3.1 ± 1.2 vs 6.1 ± 1.4, P < .001) but no change in the PO group (3.4 ± 1.3 vs 4.2 ± 0.9, P = .074) postoperatively. Multivariate logistic regression analysis indicated that a decreased postoperative 1-year AHD (odds ratio, 0.145; P = .019) was associated with a poor outcome after a graft tear.

Conclusions: A narrow postoperative 1-year AHD was identified as the most important independent risk factor indicating poor clinical outcomes after a graft tear post-ASCR, which was related to a larger tear and loss of integrity between the grafts and infraspinatus at 1-year postoperatively.

Level of evidence: Level IV, therapeutic case series.