• ABSTRACT
    • Since the introduction of superior capsular reconstruction (SCR) for the treatment of irreparable rotator cuff tears nearly 10 years ago, we have witnessed widespread adoption by the arthroscopic shoulder community alongside an exponential increase in use within North America. To date, more than 42,000 acellular dermal allografts have been implanted in the United States alone, and our indications and surgical technique have been progressively refined in response to the evolving body of clinical outcomes research. However, with P values set aside, the real question still remains: how do our patients actually do after SCR? With the advent of clinically significant outcomes such as the patient acceptability symptomatic state and substantial clinical benefit, investigators have sought to establish more practical, patient-centered benchmarks for success after an intervention. Rather than just seeking the baseline expectations via the minimally clinically important difference (i.e., "I am better"), substantial clinical benefit (i.e., "I am so much better") and patient acceptability symptomatic state (i.e., "I am 'okay' with how I feel") truly clarify patient satisfaction and provide measurable units of patient improvement. These must be assessed on an individual basis, as aggregated averages introduce outliers that can distort the outcomes. Based on these end points, prognostic factors may allow a more concrete assessment of surgical risk while equipping physicians with appropriate information to guide ideal patient selection and optimize chances of success. Patients of female sex, older age, worker's compensation status, and those with subscapularis involvement are less likely to achieve clinically significant outcomes at minimum 1-year follow-up after SCR. Based on the current study, surgeons should exercise caution in recommending SCR for patients of advancing chronological age and significant subscapularis involvement, particularly if irreparable or untreated.