Arthroscopic Superior Capsular Reconstruction for Treatment of Massive Irreparable Rotator Cuff Tears

Abstract

Massive irreparable rotator cuff tears have been troublesome entities to treat, especially in younger patients. Few good options exist, leaving most patients in recent years receiving a reverse total shoulder arthroplasty. Reverse shoulder arthroplasty carries serious risks, a limited lifespan, and no other viable options should it fail. Recent biomechanical studies have shown that the superior capsule is critical to containing the glenohumeral joint reduced, allowing the larger muscles like the deltoid and pectoralis major to function properly. The superior capsular reconstruction is an anatomic reconstruction of the superior capsule to restore the normal restraint to superior translation that occurs with a deficient rotator cuff. The technique described in this article is an arthroscopic reconstruction of the superior capsule with dermal allograft.

The “Journal of Functional Morphology and Kinesiology” Journal Club Series: Highlights on Recent Papers in Musculoskeletal Disorders

“…After a minimum follow-up period of 2 years, all clinical outcomes scores significantly improved: the American Shoulder and Elbow Surgeons score improved from 23.5 preoperatively to 92.9 postoperatively, and muscle strength significantly improved as well. Subsequently, Hirahara et al reported technical feasibility of acellular dermal allograft usage [10]. Burkhart et al identified advantages of SCR over reverse shoulder arthroplasty: (very) low infection rate, lower cost, and low morbidity [12].…”

“…In the original description of SCR, autograft fascia lata was harvested from the patient's thigh. As an alternative idea, acellular dermal allograft has been used [10][11][12]. The graft is attached medially to the superior glenoid and laterally to the greater tuberosity, arthroscopically.…”

How to Use a Graft in Irreparable Rotator Cuff Tears: A Literature Review Update of Interposition and Superior Capsule Reconstruction Techniques

“…Nearly all grafts have 5 mm added to the anterior, posterior, and medial dimensions to prevent suture pullout. A caveat to these measurements is that while some authors measure the corners of the prepared glenoid and greater tuberosity footprints [62], others place anchors first, then measure the distances between them [3,11,60,64,67]. Hirahara argues that use of the latter method creates a more accurate graft size that better matches the defect [60].…”

“…A caveat to these measurements is that while some authors measure the corners of the prepared glenoid and greater tuberosity footprints [62], others place anchors first, then measure the distances between them [3,11,60,64,67]. Hirahara argues that use of the latter method creates a more accurate graft size that better matches the defect [60]. On the lateral edge of the graft, a range of 5-15 mm is described [3,60,62,64,67], with greater sizes being used to more adequately cover and interface with the prepared greater tuberosity footprint.…”

“…Twenty relevant results [3,9,11,14,31,[58][59][60][61][62][63][64][65][66][67][68][69]70•, 71•, 72•] were returned, with animal models again excluded from this section. Again, for this update only human, clinical studies, in the English language were included.…”