Superior Capsular Reconstruction Using a Dermal Allograft Versus Reverse Total Shoulder Arthroplasty for the Treatment of Irreparable Posterosuperior Rotator Cuff Tears in Patients Aged <70 Years: A Comparative Study With Minimum 5-Year Follow-up

Background: Reverse total shoulder arthroplasty (RTSA) is the gold standard surgical procedure for irreparable posterosuperior rotator cuff tears. Superior capsular reconstruction (SCR) with acellular dermal allograft (DA) has demonstrated good short-term outcomes in younger patients. Studies that compare the 2 procedures are lacking. Purpose/Hypothesis: The purpose of the study was to compare the outcomes of these 2 surgical techniques at a minimum 5-year follow-up to evaluate their efficacy, durability, and complication profiles. It was hypothesized that RTSA would result in superior outcome scores and higher survival rates. Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively analyzed data from 69 consecutive patients .05). At follow-up, all PROMs in both treatment groups improved significantly from preoperative values ( P .05). QuickDASH (RTSA, 24.3 ± 19.5; SCR, 11.3 ± 12.0; P = .009) and SF-12 PCS (RTSA, 44.3 ± 12.2; SCR, 52.1 ± 7.8; P = .016) did differ significantly, favoring SCR. Sports participation was moderately below the preinjury level in both groups (RTSA, <25% to 50%–65%; SCR, 25%–49% to 75%–99%) but improved significantly only in the SCR group ( P = .009). Satisfaction was similar in both groups, with a median of 9 (range, 1-10). Conclusion: In treating irreparable posterosuperior rotator cuff tears in younger patients, RTSA demonstrated superior survivorship (90.1%) compared with SCR with DA (75.0%) at mid-term follow-up. However, in patients without treatment failure, both RTSA and SCR had equal improvements in most PROMs at ≥5 years of follow-up, with some scores favoring SCR in nonfailure cases. Higher sports participation, PCS, and lower disability were noted in the SCR group.