Superior Capsule Reconstruction: The US Perspective

Abstract

Irreparable massive rotator cuff tears in active middle-aged patients result in significant shoulder dysfunction and pose a particular challenge with regard to selection of optimal treatment. Superior capsule reconstruction (SCR) is a joint-preserving surgical option to restore glenohumeral stability and prevent superior humeral head migration, thereby improving shoulder function, lessening pain, and limiting development of rotator cuff arthropathy. Indications for SCR are irreparable supraspinatus and/or infraspinatus tears with persistent shoulder pain and/or dysfunction that have failed conservative treatment in a patient who is not an ideal candidate for arthroplasty due to age or activity level. Patients need to have relatively preserved glenohumeral cartilage, an intact or repairable subscapularis tendon, and a fully functioning deltoid muscle to be an appropriate candidate for SCR. SCR was originally described by Dr. Teruhisa Mihata using fascia lata autograft; however, in the United States and most of North America, dermal allograft is the most common graft choice. The graft is secured medially to the superior glenoid with two or three suture anchors and laterally to the tuberosity commonly using four anchors in a double row configuration. Preliminary clinical studies demonstrate significant improvement in pain, function, muscle strength, active shoulder range of motion with resolution of pseudoparalysis, normalization of the acromiohumeral interval and no rapid progression of osteoarthritis.