[Mid-term clinical outcomes of supraspinatus tendon reconstruction versus superior capsular reconstruction for the treatment of irreparable posterosuperior massive rotator cuff tears].

Objective: To compare the mid-term clinical efficacy of supraspinatus tendon reconstruction (STR) and superior capsule reconstruction (SCR) for irreparable posterosuperior massive rotator cuff tears (RCTs). Methods: A retrospective analysis was conducted on 27 patients with irreparable posterosuperior massive RCTs treated at the First Affiliated Hospital of Army Medical University between October 2019 and November 2022. The patients were stratified into two groups according to operation procedures: 11 cases underwent STR(STR group), 1 male and 10 females with an average of (65.0±8.3) years; 16 cases underwent SCR (SCR group), 3 males and 13 females with a mean age of (59.6±8.0) years. Preoperative and 24-month postoperative outcomes were assessed and compared using the visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and University of California Los Angeles (UCLA) score between the two groups. Imaging parameters included acromiohumeral distance (AHD), Sugaya grades, and Goutallier grading. Active shoulder range of motion (ROM) was also recorded. Results: Baseline characteristics were comparable between the two groups (all P>0.05). At 24 months postoperatively, both groups showed improved active ROM, but there was no significant difference in ROM improvement between the two groups [flexion: STR 100.0°(90.0°, 110.0°) vs SCR 85.0° (51.3°, 97.5°); abduction: STR 99.1°±30.2° vs SCR 79.4°±28.8°; internal rotation vertebral level 5.0 (4.0, 6.0) vs 4.5 (1.0, 6.0), and external rotation 30.0° (20.0°, 50.0°) vs 30.0° (20.0°, 39.8°)](all P>0.05). However, the STR group demonstrated significantly greater improvements in VAS [(6.0 (5.0, 6.0) vs 4.0 (3.3, 5.0)], ASES (57.9±8.2 vs 48.0±12.4), and Constant-Murley score [69.0(57.0, 73.0) vs 56.5 (45.5, 61.3)] when compared to those in SCR (P<0.05). In addition, both the STR and SCR group demonstrated significant improvement in AHD compared to preoperative measurements, with no statistically significant intergroup difference in the extent of improvement (all P>0.05). Similarly, postoperative Sugaya classification showed no significant differences between the two groups (P>0.05). However, the STR group exhibited significantly better improvement in Goutallier grading compared to preoperative status (P=0.021). Conclusions: Both STR and SCR can improve shoulder ROM in patients with irreparable posterosuperior massive rotator cuff tears. However, STR demonstrates superior efficacy in alleviating pain and reducing fat infiltration, yielding better mid-term clinical outcomes.