AOSSM/AANA Specialty Day 2020-Handout - Results Justify

Handout - Results Justify_ Why I’m Doing an SCR

Pdf Summary

Dr. John M. Tokish presents a detailed analysis on managing massive irreparable rotator cuff tears, focusing on Superior Capsular Reconstruction (SCR) as a transformative treatment option. Traditional treatments—such as debridement with biceps tenotomy—relieve pain but often fail to restore function and have a high conversion rate to arthroplasty. Reverse shoulder arthroplasty offers some functional improvement, but with limited longevity and a substantial failure rate, especially in younger patients.<br /><br />SCR, introduced around 2013, involves using a graft (often tensor fascia lata autograft) to stabilize the shoulder by reconstructing the superior capsule. Early results are promising, showing substantial improvements in pain relief and function (ASES scores improving dramatically). In a 5-year follow-up of 30 patients, those with healed grafts had excellent outcomes and no progression to cuff tear arthropathy (CTA). However, graft failure—especially on the humeral side—and patient selection (including stage of disease and subscapularis integrity) significantly affect results. Failures tend to occur with thin grafts or advanced disease (Hamada stage 3). <br /><br />Approximately 18,000 SCR procedures were performed worldwide by 2018, yielding good patient satisfaction and pain relief but with a concerning structural failure rate near 9%. Different graft types (autograft vs. allograft) and thicknesses may influence outcomes, and researchers explore “SCR Plus” procedures combining SCR with force couple restoration techniques for enhanced function.<br /><br />Dr. Tokish emphasizes SCR as a game-changing but not final-step intervention; careful patient selection and surgical technique refinement are critical. Ongoing advancements include optimizing graft materials, incorporating biologics, and enhancing repair methods. SCR represents a significant advance in treating massive irreparable cuff tears, offering rapid pain relief and functional restoration, while acknowledging the need for continued improvement and long-term durability.

Keywords

Massive irreparable rotator cuff tears

Superior Capsular Reconstruction (SCR)

Reverse shoulder arthroplasty

Tensor fascia lata autograft

Graft failure

Patient selection criteria

Cuff tear arthropathy (CTA)

SCR Plus procedures

Pain relief and functional improvement

Surgical technique advancements