Partial Repair and Superior Capsular Reconstruction Both Improve Outcomes for Irreparable Posterosuperior Rotator Cuff Tears: A Systematic Review.

PURPOSE: To synthesize patient-reported outcome measures, failure rates, and mobility parameters for comparison of partial repair versus superior capsular reconstruction (SCR) in the treatment of irreparable posterosuperior rotator cuff tears.

METHODS

EMBASE, OVID Medline, and Emcare were searched from database inception to November 2024 for studies on irreparable rotator cuff tears treated with partial repair (PR) or SCR. Eligible studies included adults (≥18 years) reporting recurrence or failure rates and patient-reported outcome measures. Risk of bias was assessed using the Risk of Bias 2.0 tool for randomized controlled trials and the Methodological Index for Non-Randomized Studies criteria for all other studies. Due to study heterogeneity, a descriptive synthesis was conducted. Individual study results were displayed using forest plots without pooled estimates.

RESULTS

Twenty-eight studies comprising 1199 patients were included. In SCR studies, final American Shoulder and Elbow Surgeons scores often exceeded 80, and Visual Analogue Score pain scores improved by 4 to 5 points. In PR studies, postoperative American Shoulder and Elbow Surgeons scores generally ranged from 77.0 to 86.0, and Visual Analogue Score pain scores typically decreased to below 2.0. Failure rates ranged from 5.0% to 38.9% for SCR and 3.3% to 84.8% for PR. Gains in forward elevation ranged from 24.6° to 73.0° in SCR studies and from 9.5° to 51.7° in PR studies, with considerable variability reported across both groups. External rotation improved in both groups, though results were inconsistent. All SCR studies reporting Constant-Murley Scores exceeded 70.0, while only 1 PR study reached this threshold. Complications were more frequently reported in SCR studies, including persistent pain and stiffness.

CONCLUSIONS

SCR and PR both showed improvements in pain, functional scores, and range of motion for patients with irreparable posterosuperior rotator cuff tears. Outcomes varied considerably across studies, reflecting heterogeneity in patient selection, surgical technique, and reporting practices.

LEVEL OF EVIDENCE: Level III, systematic review of Level II and Level III studies.