Superior Capsular Reconstruction With the Mini-open Keyhole Technique Using Achilles Allograft Shows Favorable Outcomes for Patients With Preoperative Pseudoparalysis but Worse Outcomes and Strength With Longer Duration of Pseudoparalysis

Abstract

Purpose

To analyze whether superior capsular reconstruction (SCR) with a keyhole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and to identify preoperative factors that influence clinical outcomes.

Methods

Between January 2018 and October 2021, patient data were retrospectively collected from SCR patients who underwent our institution’s keyhole technique using Achilles allograft with minimum 2-year follow-up. Patients were categorized into 2 groups: pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of the shoulder, clinical scores (Constant score and visual analog scale [VAS] pain score), and muscle strength were assessed preoperatively and at 2 years postoperatively. In addition, the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group.

Results

A total of 69 patients who underwent SCR with the keyhole technique using Achilles graft were included in this study. The P and NP groups had 24 cases and 45 cases, respectively. Preoperative ROM (forward elevation [FE] and external rotation [ER]), Constant score, and muscle strength (FE and ER) were significantly lower in the P group than the NP group. At 2-year follow-up, active ROM (FE, P < .001; ER, P < .001), Constant score, VAS score, and muscle strength (FE, P < .001; ER, P < .001) were improved in the P group. In the P group, pseudoparalysis recovered in 21 of 24 patients (87.5%) at 2 years after surgery. In terms of patient-reported outcomes, the minimal clinically important differences in the Constant score and VAS score were 8.15 and 1.05, respectively, in the P group and 9.47 and 0.92, respectively, in the NP group. Among the 3 cases in which pseudoparalysis recovery failed, 2 were due to graft failure and 1 had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative ER strength were associated with worse clinical outcomes.

Conclusions

SCR with the mini-open keyhole technique using Achilles allograft shows favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR patients with pseudoparalysis, careful attention is needed because those with a longer pseudoparalysis duration and weaker ER strength could have a tendency toward worse postoperative outcomes.

Level of Evidence

Level III, retrospective cohort study.