الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
RCTs represent one of the most common shoulder injuries in population over 50 years and with a progressive pattern of injury.
RCTs are categorized into partial tears, complete tears, massive reparable tears, chronic massive irreparable tears, and cuff arthropathy.
Differentiation between massive and irreparable tears is important, as not all massive tears are irreparable. Massive tears can be defined as tears > 5 cm, or tears involving two or more tendons, or tear in which tendon is retracted beyond the top of the humeral head. Irreparable rotator cuff tears can be defined as massive irreparable tears which cannot be repaired back to footprint on greater tuberosity, or functional irreparable tears which result in unacceptably high retear rates postoperatively up to 94% due to muscle atrophy and fatty infiltration.
In MIRCTs there is no optimal treatment as many treatment options are available and mixed results are present due to variability in cuff conditions and techniques. Management of massive rotator cuff tears (MRCTs) include debridement, biceps tenotomy/tenodesis, partial repair with or without interval slide, tuberoplasty, insertion of biodegradable spacer, patch augmentation, tendon transfer procedures, RTSA and SCR.
SCR of the shoulder has recently gained popularity as an option for joint-preserving shoulder surgery for patients with an irreparable rotator cuff tear. In the absence of glenohumeral arthritis, rotator cuff tear irreparability should only be diagnosed for most patients after a careful diagnostic arthroscopy.
SCR function by providing a superior static restraint to the superior migration of the humeral head restoring coronal force couple and restoring stable fulcrum for remaining rotator cuff to improve glenohumeral kinematics. It may also function by spacer effect, as the graft thickness does matter in outcomes and in reducing subacromial contact pressure which could explain the spacer effect of graft.
There are a variety of reported techniques for performing SCR depending on the type of the graft (fascia lata, extracellular matrix dermal grafts, LHBT, hamstrings tendon autograft, Achilles tendon-bone allograft and fascia lata autograft reinforced with nonresorbable suture mesh), whether performed in an open manner or arthroscopically, the mode of the glenoid and greater tuberosity fixation, and whether the anchors are all inserted before or after passage of the graft.
The original arthroscopic technique described by Mihata involved using FLA. Hirahara et al modified the original technique by using HDA instead of the fascia lata.
Rehabilitation for this procedure is slow and requires six weeks in a sling with slow progression of strengthening until 12-16 weeks. The purpose of the slow rehabilitation is to promote graft healing while minimizing the risk of graft failure.
Literature search and filtration on superior capsular reconstruction in massive irreparable rotator cuff tears yielded 12 studies.
Results of our study showed promising Short-term and medium-term results regarding SCR in MIRCTs. ROM showed improvement in active elevation, external rotation, abduction, and internal rotation. Pseudoparalytic patients showed improvement and reversal of pseudoparalysis in most of them. Patient reported outcomes showed improvement and promising results regardless of type of graft used. Complication rates are relatively low with the main complication reported to be graft retear.
Review of the enrolled studies showed that SCR showed promising early results and represents a good joint preserving technique in management of MIRCTs in young active patients without rotator cuff arthropathy and intact or reparable subscapularis tendon. Long term studies and comparative studies are needed to confirm the results.