The Number of Surgeons Using Superior Capsular Reconstruction for Rotator Cuff Repair Is Declining

Abby C Hankins; Justin W Griffin; John P Taliaferro; Brian C Werner; Kevin F Bonner

doi:10.1016/j.asmr.2022.10.002

The Number of Surgeons Using Superior Capsular Reconstruction for Rotator Cuff Repair Is Declining

Arthrosc Sports Med Rehabil. 2022 Nov 17;4(6):e2089-e2098. doi: 10.1016/j.asmr.2022.10.002. eCollection 2022 Dec.

Authors

Abby C Hankins¹, Justin W Griffin^{1

2}, John P Taliaferro³, Brian C Werner⁴, Kevin F Bonner^{1

2}

Affiliations

¹ Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.
² Jordan-Young Institute, Virginia Beach, Virginia, U.S.A.
³ Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.
⁴ Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia, U.S.A.

Abstract

Purpose: To investigate surgeon preferences for graft use, including biologic augmentation and superior capsular reconstruction (SCR) associated with surgical treatment of rotator cuff repair (RCR).

Methods: A 26-question survey was completed by arthroscopic shoulder surgeons. Surgeon demographics were evaluated. Surgeons were queried about shoulder arthroscopic graft use and rationale then responses were analyzed based on demographics.

Results: In total, 260 surgeons completed the survey. Fifty-one percent of surgeons reported a decrease in the volume of SCR use in the past 5 years. Less than 3% of surgeons used SCR in >90% of irreparable RCR cases, compared with 38% using SCR in <10% of irreparable cases (P < .05). Surgeons performing >100 RCR annually (42%; P < .05) and those employed in the hospital setting (44%; P < .05) reported an overall increase in the use of SCR. More international surgeons (67%) decreased their use of SCR compared with U.S. surgeons (44%; P < .05). In contrast, bioinductive graft use is generally on the rise, with 48% of surgeons reporting increased use since first use, although used in <10% of cases by 54% of surgeons. Sixty-eight percent of surgeons performing >100 RCRs annually used bioinductive grafts (P < .05). Fewer international surgeons (30%) performed biologic augmentation (P < .05). Suboptimal published outcomes (40%) and no perceived patient benefit (40%) were most cited for decreased SCR use. Surgeons reporting increased use cited improved personal patient outcomes (72%).

Conclusions: Arthroscopic surgeons report decrease in volume of SCR use in the past 5 years. Surgeon's personal experience of patient outcome and suboptimal published results were the strongest factors impacting decision-making. In contrast, bioinductive graft use is increasing. However, most surgeons use these grafts in a relatively small percentage of cases.

Clinical relevance: Evaluation of scientific data, personal experience, and influences on surgical practice will give a comprehensive understanding of current RCR practices.