Failure Rate After Superior Capsular Reconstruction With Achilles Tendon-Bone Allograft for Irreparable Rotator Cuff Tears

Background: Superior capsular reconstruction (SCR) is an alternative to reverse shoulder arthroplasty for irreparable rotator cuff tears (IRCTs). The reconstructed capsule acts as a static restraint to prevent superior migration of the humeral head. Traditional SCR uses a fascia lata autograft, which has shown failure at the greater tuberosity. An Achilles tendon-bone allograft has been proposed to improve the failure rate. Purpose: To evaluate the surgical outcomes of SCR using an Achilles tendon-bone allograft for the treatment of IRCTs. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively evaluated 6 patients with massive IRCTs who underwent SCR using an Achilles tendon-bone allograft between January 2017 and January 2018. Clinical outcomes were assessed using range of motion, the American Shoulder and Elbow Surgeons score, and the visual analog scale for pain. The acromiohumeral distance and the status of graft integrity were evaluated using serial magnetic resonance imaging. Second-look arthroscopy surgery was performed to evaluate graft integrity at the mean of 7.5 months postoperative. Results: The mean SD clinical follow-up period was 14.5 months (range, 12-17 months). The American Shoulder and Elbow Surgeons and visual analog scale scores improved from 42.8 +/- 11.9 and 4.0 +/- 1.2 to 62.1 +/- 14.7 and 2.8 +/- 1.4, respectively. Forward flexion and external rotation improved from 98 degrees +/- 36 degrees and 58 degrees +/- 4 degrees to 123 degrees +/- 20 degrees and 39 degrees +/- 8 degrees, respectively. The acromiohumeral distance improved from 3.9 +/- 0.8 mm to 6.4 +/- 2.2 mm at final follow-up. However, second-look arthroscopy at a mean of 7.6 months postoperatively confirmed a graft failure rate of 83.3%. Conclusion: SCR using an Achilles tendon-bone allograft for the treatment of IRCTs had a high graft failure rate among patients in this case series.