Superior Capsular Reconstruction With the Mini-open Keyhole Technique Using Achilles Allograft Shows Favorable Outcomes for Patients With Preoperative Pseudoparalysis but Worse Outcomes and Strength With Longer Duration of Pseudoparalysis.

ABSTRACT

PURPOSE: To analyze whether superior capsular reconstruction (SCR) with a keyhole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and to identify preoperative factors that influence clinical outcomes. METHODS: Between January 2018 and October 2021, patient data were retrospectively collected from SCR patients who underwent our institution's keyhole technique using Achilles allograft with minimum 2-year follow-up. Patients were categorized into 2 groups pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of the shoulder, clinical scores (Constant score and visual analog scale [VAS] pain score), and muscle strength were assessed preoperatively and at 2 years postoperatively. In addition, the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group. RESULTS: A total of 69 patients who underwent SCR with the keyhole technique using Achilles graft were included in this study. The P and NP groups had 24 cases and 45 cases, respectively. Preoperative ROM (forward elevation [FE] and external rotation [ER]), Constant score, and muscle strength (FE and ER) were significantly lower in the P group than the NP group. At 2-year follow-up, active ROM (FE, P < .001; ER, P < .001), Constant score, VAS score, and muscle strength (FE, P < .001; ER, P < .001) were improved in the P group. In the P group, pseudoparalysis recovered in 21 of 24 patients (87.5%) at 2 years after surgery. In terms of patient-reported outcomes, the minimal clinically important differences in the Constant score and VAS score were 8.15 and 1.05, respectively, in the P group and 9.47 and 0.92, respectively, in the NP group. Among the 3 cases in which pseudoparalysis recovery failed, 2 were due to graft failure and 1 had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative ER strength were associated with worse clinical outcomes. CONCLUSIONS: SCR with the mini-open keyhole technique using Achilles allograft shows favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR patients with pseudoparalysis, careful attention is needed because those with a longer pseudoparalysis duration and weaker ER strength could have a tendency toward worse postoperative outcomes. LEVEL OF EVIDENCE Level III, retrospective cohort study.