JSES - 2026-05-12 - Journal Article
Clinical Outcomes following Bursal Acromial Reconstruction for Irreparable Rotator Cuff Tears.
Villacis DC
Topics
Key Takeaway
Bursal acromial reconstruction for irreparable rotator cuff tears improved mean ASES by 46 points and VAS by 4.9 points at 2 years, with 3 of 22 patients (14%) requiring conversion to rTSA.
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Summary
This single-surgeon retrospective study evaluated arthroscopic bursal acromial reconstruction—placement of allograft on the acromial undersurface—in 22 patients with irreparable rotator cuff tears, preserved forward elevation ≥120°, and no advanced glenohumeral arthritis. At minimum 2-year follow-up, VAS improved by 4.9, ASES by 46, and SANE by 49 points (all p<0.001), with mean satisfaction 8.7/10. Three patients (14%) required conversion to rTSA within the follow-up period.
Key Limitation
With only 22 patients and no comparator group, the study cannot determine whether outcomes are superior, equivalent, or inferior to superior capsular reconstruction, balloon spacer, or rTSA in the same patient population.
Original Abstract
BACKGROUND
Irreparable rotator cuff tears remain a challenge for orthopedic surgeons. Reverse shoulder arthroplasty (rTSA) has become an increasingly common option for these patients. However, in patients lacking arthritis and with a functionally balanced shoulder, alternative and less invasive surgical options have been pursued. In this study we seek to investigate the outcome of arthroscopically placing an allograft on the undersurface of the acromion for pain relief.
METHODS
A retrospective review was conducted of all patients who underwent a bursal acromial reconstruction by a single surgeon. To qualify for inclusion patients were required to have what was deemed an irreparable rotator cuff tear, absence of advanced osteoarthritis, a functionally balanced shoulder preoperatively as evidenced with intact forward elevation of at least 120 degrees, and a minimum of 2 year follow-up. Clinical outcomes were measured preoperatively, 3 months, and at final 2 year follow-up using visual analogue scale for pain (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Single-Assessment Numeric Evaluation (SANE) score. A one-way analysis of variance (ANOVA) test was used to determine significant difference between preoperative and final follow-up. An additional satisfaction survey was completed at final follow-up.
RESULTS
Twenty two patients were included in the study. 3 patients were converted to reverse shoulder arthroplasty during the follow up period due to limited active range of motion. The remaining patients had a significant improvement in VAS, ASES and SANE scores (p<0.001). The average improvement in VAS, ASES, and SANE score at final follow up was 4.9, 46, and 49, respectively. The average satisfaction score at final follow-up was 8.7 (95% CI, 7.9 to 9.5) on a scale from 1 to 10. There were no major or minor complications.
CONCLUSION
Bursal Acromial Reconstruction in the setting of an irreparable rotator cuff tear, with a functionally balanced shoulder in the absence of osteoarthritis, is effective at improving patient reported outcomes and producing high patient satisfaction. However, it was associated with a conversion to reverse shoulder arthroplasty within 2 years in 3 of the 22 patients. This surgical technique presents a potential alternative to reverse shoulder arthroplasty for this subset of patients with an irreparable rotator cuff tear who have failed conservative treatment. Further research is warranted to investigate how these outcomes compare to other procedures in high level randomized control trials and if these outcomes can be sustained with longer follow-up.