Arthroscopy - 2026-08-30 - Journal Article; Review
Improvements in Patient-Reported Outcome Measures and Range of Motion After Rotator Cuff Repair, Superior Capsular Reconstruction, and Tendon Transfer May Not Necessitate Increases in Acromiohumeral Interval for Massive or Irreparable Rotator Cuff Tears: A Systematic Review.
Saad Berreta R, Villarreal-Espinosa JB, Vega TF, Dave U, Joyce K, Lee C, Jackson GR, Khan Z, Ayala S, McCormick J, Scanaliato JP, Verma NN
Topics
Key Takeaway
Across 1,868 patients and three surgical strategies for massive/irreparable rotator cuff tears, functional outcomes and forward flexion improved equivalently whether or not AHI increased significantly (range of AHI change: -3.2 to +5.3 mm).
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Summary
This systematic review asked whether AHI restoration is necessary for clinical improvement after RCR, SCR, or TT for massive/irreparable rotator cuff tears. Sixty cohorts were stratified by whether they achieved statistically significant AHI improvement; ASES, UCLA, VAS, Constant scores, and forward flexion were then compared between groups. Mean functional gains were comparable regardless of AHI change, with significant-AHI cohorts gaining 0.40–5.3 mm and non-significant cohorts ranging from -3.2 to +0.7 mm.
Key Limitation
Qualitative cohort-level comparison without patient-level data prevents controlling for baseline AHI, tear size, fatty infiltration grade, or procedure-specific variables that confound the AHI–outcome relationship.
Original Abstract
PURPOSE
To perform a systematic review investigating the relation between improvements in patient-reported outcomes and range of motion with changes in acromiohumeral interval (AHI) after rotator cuff repair (RCR), tendon transfer (TT), and superior capsular reconstruction (SCR) for massive or irreparable rotator cuff tears.
METHODS
A literature search was performed using 3 databases from inception to December 2023 according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Human clinical studies reporting changes in AHI after RCR, SCR, and TT for massive or irreparable rotator cuff tears were included. A qualitative comparison across studies that reported either statistically significant improvement or no significant improvement in AHI to patient-reported outcomes and range of motion was conducted. Study quality was assessed using the Cochrane Collaboration's risk of bias tool and the Methodological Index for Non-Randomized Studies criteria.
RESULTS
Forty-two studies including 1868 patients (362 RCR, 1101 SCR, and 405 TT) across 60 individual cohorts (10 RCR, 39 SCR, and 11 TT) were identified. Forty-four cohorts (8 RCR, 31 SCR, and 5 TT) representing 1374 patients noted a statistically significant improvement in AHI ranging from 0.40 to 5.3 mm. Sixteen cohorts (2 RCR, 8 SCR, and 6 TT) representing 494 patients noted no statistically significant improvement in AHI ranging from -3.2 to 0.7 mm. The mean improvement from baseline to final follow-up across American Shoulder and Elbow Surgeons, University of California-Los Angles, Visual Analog Scale Pain, and Constant scores in addition to forward flexion were comparable across both groups.
CONCLUSIONS
Improvements in functional outcome measures and forward flexion after soft tissue reconstruction for massive or irreparable rotator cuff tears are observed regardless of whether the AHI increases significantly from baseline.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II to IV studies.