BRIDGING RECONSTRUCTION VERSUS SUPERIOR CAPSULAR RECONSTRUCTION: RADIOLOGICAL COMPARISON. RESULTS OF A PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL

Large or massive rotator cuff tears make up approximately 10-40% of all rotator cuff tears, however, there is no agreement on the optimal treatment. Bridging rotator cuff reconstruction (BRR) and superior capsular reconstruction (SCR) have been described with acellular human dermal allograft and have shown satisfying clinical results. The main objective of this study was to compare the radiographic outcomes of patients who received BRR and SCR. A prospective, randomized controlled trial was conducted to compare BRR to SCR for large to massive, retracted rotator cuff tears. Forty-six patients were intraoperatively randomized following partial repair to BRR or SCR using human dermal allograft. All patients received pre- and post-operative (~12-months) x-rays and MRIs. The primary outcome was acromiohumeral interval (AHI), pre- and post-operatively between the groups. Secondary outcomes included graft retear rate and progression of muscle atrophy and fatty infiltration on MRI. There were no differences in age, gender, BMI, or pre-operative tear size between the two cohorts. The SCR group had a significant decrease in AHI (-1.95 ± 3.08 mm; p=0.006), whereas the BRR group had slight improvement (0.84 ± 2.55 mm; p=0.126). The BRR group had significantly better mean postoperative AHI and pre-to post-operative AHI difference compared to the SCR group (p=0.017 and p=0.002, respectively). There was no difference between the groups in complete retear rate (BRR: 5%, SCR: 19%; p=0.373). The SCR group had a significant increase in supraspinatus and infraspinatus mean muscle atrophy from post-operatively (p < 0 .001 & p=0.002; respectively). The BRR group showed no change in supraspinatus or infraspinatus mean muscle atrophy (p=0.857 & p=0.440; respectively). There was no difference between the groups in the number of patients who had progression of fatty infiltration. The findings of this prospective randomized controlled trial highlights the effectiveness of BRR compared to SCR in maintaining AHI and preserving infraspinatus muscle integrity, while exhibiting a comparable retear rate. BRR demonstrated superior radiographic outcomes with minimal retear rates, suggesting its reliability in halting rotator cuff arthropathy progression.