Reconstruction Reverses Pseudoparalysis in Rotator Cuff Tears

Arthroscopic superior capsule reconstruction (ASCR) to treat irreparable rotator cuff tears may eliminate pseudoparalysis and significantly improve shoulder function, according to a new study.

Developed by researchers at Osaka Medical College, ASCR involves using the deep fascia of the thigh as a tissue graft which attached medially to the superior tubercle of the glenoid and laterally to the greater tuberosity, with concomitant arthroscopic repair of the torn subscapularis tendon. Side-to-side sutures are added between the graft and the infraspinatus tendon, and between the graft and the subscapularis tendon, in order to improve force coupling in the shoulder joint.

A new study involving 90 patients who were eligible for ASCR divided them into three groups by level of pseudoparalysis prior to surgery - none, moderate, or severe, based on extent of arm elevation. The patients underwent magnetic resonance imaging (MRI) scans at 3, 6 and 12 months post-surgery, as well as a series of physical tests. The results showed that 96.3% of patients with moderate pseudoparalysis and 93.3% with severe pseudoparalysis regained motion in their shoulder. The study was presented at the American Orthopaedic Society for Sports Medicine's (AOSSM) specialty day, held during March 2017 in San Diego (CA, USA).

"Rotator cuff tears can result in pain and loss of function in the shoulder. Our latest research shows this surgical approach is an asset to helping these patients not only relieve pain, but hopefully return to full shoulder motion and an active lifestyle,” said lead author Teruhisa Mihata, MD, PhD. “Overall, all patients showed improved shoulder function and stability after surgery.”

Massive rotator cuff tears comprise approximately 20% of all cuff tears and approximately 80% of recurrent rotator cuff tears. Some patients with massive cuff tears are functional with limited pain, while others are severely debilitated and can present with pseudoparalysis of the shoulder, which is defined as active forward flexion less than 90° with full passive motion (the inability to actively raise the affected arm above shoulder level).