BRIDGING RECONSTRUCTION REVEALS IMPROVED OUTCOMES: A RANDOMIZED TRIAL VERSUS SUPERIOR CAPSULAR RECONSTRUCTION

Large or massive rotator cuff tears comprise 10–40% of all cases, with considerable debate on the best treatment approach. These complex injuries often involve multiple tendon tears and can lead to substantial pain, loss of function, and disability. Selecting the optimal surgical technique for these injuries has been widely debated, as each approach has unique advantages and limitations. Bridging rotator cuff reconstruction (BRR) and superior capsular reconstruction (SCR) are two established techniques aimed at restoring shoulder balance and function. BRR uses grafts to bridge the gap between torn tendons, while SCR focuses on reconstructing the superior capsule to maintain joint integrity. Both methods have shown promising clinical outcomes, yet only limited studies have directly compared them. This study aimed to evaluate functional and self-reported outcomes in patients who received BRR or SCR using human dermal allograft. In this randomized control trial, 60 patients with large (> three cm), two-tendon rotator cuff tears were randomized into the SCR or BRR group. All patients completed patient reported outcomes (PROs) (Western Ontario Rotator Cuff Index (WORC) and Disabilities of the Arm, Shoulder, Hand (DASH)) as well as strength and range of motion (ROM) of the shoulder pre- and post-operatively (six-, 12-, 24-months). PROs and functional outcomes were statistically analyzed between and within groups at each time point, respectively. Significance was set to 0.05. Patients in both groups had similar demographics (p>0.05). All groups demonstrated significant improvement in WORC and DASH post-operatively at six, 12-, and 24-months from baseline (p < 0 .001). At baseline, six-, and 12-months, WORC was not significantly different between groups, however, post-operatively at 24-months, BRR group had a significantly greater outcome (19.65 ± 18.8) than the SCR group (32.33 ± 20.92) (p=0.034). There were no significant differences for DASH between the two groups at any time. There were no significant differences in strength between groups at any time point, with both showing minimal, non-significant improvement at six months post-operation. At 12 months post-operation, both groups began showing significant improvements, with the SCR group gaining in abduction, internal rotation, and flexion, and the BRR group in flexion only. By 24 months, the SCR group continued to improve in abduction, external rotation, and flexion, while the BRR group showed significant gains in external rotation, internal rotation, and flexion. Average strength improvements were about 5 lbs for the SCR group and 4.5 lbs for the BRR group. No significant differences in ROM were found. This study demonstrates that both BRR and SCR using human dermal allograft significantly improve patient-reported outcomes, and strength in patients with large rotator cuff tears. While both groups experienced significant improvements, the BRR group showed slightly greater functional gains over time, suggesting that BRR with dermal allograft may offer some advantages in terms of recovery and shoulder performance. Long-term follow-up studies are warranted to further investigate the durability of these outcomes. This study contributes valuable data to the ongoing discussion regarding optimal treatment for large rotator cuff tears and supports the continued use of BRR and in clinical practice.