Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

Abstract

Massive irreparable rotator cuff tears in young patients are a particular challenge for the orthopaedic surgeon. Surgical treatment options include debridement, partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and reverse total shoulder arthroplasty. Recently, reconstruction of the superior glenohumeral capsule using a fascia lata autograft has been suggested to reduce superior glenohumeral translation and restore superior stability. Promising clinical results have been reported in 1 case series of 23 patients, indicating that superior capsular reconstruction may be a promising tool to manage massive irreparable rotator cuff tears. This article describes our preferred technique for arthroscopic superior capsule reconstruction. M assive irreparable rotator cuff tears involving the posterosuperior rotator cuff are challenging to treat. Many treatment options exist, including debridement, partial rotator cuff repair, 1 patch-augmented rotator cuff repair, 2 bridging rotator cuff reconstruction with a graft, 3 latissimus dorsi tendon transfer, and superior capsule reconstruction. 4 If joint space narrowing with cuff tear arthropathy is present or when the subscapularis is also irreparable, reverse total shoulder arthroplasty is indicated. The shoulder capsule is an important static stabilizer of the glenohumeral joint, with the anterior capsule maintaining anterior glenohumeral stability whereas the posterior capsule provides posterior stability. 5