PURPOSE:
The purpose of this systematic review is to characterize the complications associated with superior capsule reconstruction (SCR) for the treatment of functionally irreparable rotator cuff tears (FIRCTs).

METHODS:
This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two independent reviewers completed a search of PubMed, Embase, and Medline databases. Studies were deemed eligible for inclusion if they reported postoperative outcomes of arthroscopic SCR for FIRCTs and considered at least 1 postoperative complication. Statistical heterogeneity was quantified via the I2 statistic. Due to marked heterogeneity, pooled proportions were not reported. All complications and patient-reported outcomes were described qualitatively.

RESULTS:
Fourteen studies met the inclusion/exclusion criteria. The overall complication rate post-SCR ranged from 5.0% to 70.0% (I2 = 84.9%). Image-verified graft retear ranged from 8% to 70%, I2 = 79.4%), with higher rates reported when SCR was performed using allograft (19%-70%, I2 76.6%) compared to autograft (8%-29%, I2 = 66.1%). Reoperation (0%-36%, I2 = 73.4%), revision surgeries (0%-21%, I2 = 81.2%), medical complications (0%-5%, I2 = 0.0%), and infections (0%-5%, I2 = 0.0%) were also calculated.

CONCLUSIONS:
SCR carries a distinct complication profile when used for the treatment of FIRCTs. The overall rate of complications ranged from 5.0% to 70.0%. The most common complication is graft retear with higher ranges in allografts (19%-70%) compared to autografts (8%-29%). The majority of studies reported at least 1 reoperation (range, 0%-36%), most commonly for revision to reverse shoulder arthroplasty.

LEVEL OF EVIDENCE:
Level IV, systematic review of Level IV or better investigations.



Polls results
1

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
82% Article relates to my practice (61/74)
14% Article does not relate to my practice (11/74)
2% Undecided (2/74)
2

Will this article lead to more cost-effective healthcare?

75% Yes (56/74)
17% No (13/74)
6% Undecided (5/74)
3

Was this article biased? (commercial or personal)

6% Yes (5/74)
89% No (66/74)
4% Undecided (3/74)
4

What level of evidence do you think this article is?

5% Level 1 (4/74)
13% Level 2 (10/74)
29% Level 3 (22/74)
50% Level 4 (37/74)
1% Level 5 (1/74)