Superior Capsule Reconstruction

Superior Capsule

The upper part of the capsular lining of your shoulder joint is the superior capsule. A rotator cuff is a group of 4 muscles in the shoulder joint including the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles originate in the scapula and attach to the head of the humerus through tendons. The rotator cuff forms a sleeve around the humeral head and glenoid cavity, providing stability to the shoulder joint while enabling a wide range of movements.

Superior Capsular Reconstruction (SCR)

Superior Capsular Reconstruction is a surgical procedure to repair massive, irreparable rotator cuff tears. The surgery involves the reconstruction of the superior capsule of the shoulder joint using an autograft (tissue from the same person) or an allograft (tissue from a donor).

Indications for Arthroscopic SCR

Superior capsule reconstruction is indicated for massive rotator cuff tears that cannot be repaired. Such tears are characterized by the size and extent of retraction of the tears. Superior capsule reconstruction is suggested when

• The initial attempt at repairing the tears, by mobilization and soft-tissue release, fails
• Arthritis of the glenohumeral joint (chondromalacia)
• The presence of a sufficient amount of healthy bone allows the fixation of anchors
• Minimal migration of the humerus
• Intact teres minor and subscapularis muscles of the rotator cuff

Arthroscopic SCR Procedure

Surgery is performed through arthroscopy. An arthroscope is a small, fiber-optic instrument consisting of a lens, light source, and video camera. The camera projects images of the inside of the joint onto a large monitor, allowing your surgeon to look for any damage, assess the type of injury and repair it.

The surgical procedure involves the following steps:

• You will lie in a decubitus position (towards your side).
• You may be given general anesthesia and regional anesthesia.
• Your surgeon makes cutaneous marks for the incisions.
• A small incision is made on the skin near the shoulder joint.
• Arthroscopic portals are inserted.
• Partial repair of the rotator cuff is performed.
• The bones of the shoulder joint are prepared for graft placement.
• Suture anchors are placed.
• The graft is passed and secured with sutures.
• The suture strands are secured further by lateral anchors (double row technique).
• Your surgeon assures that the graft is secured to the humeral head.
• A final assessment of the shoulder is performed, and the incision is closed.

Post-operative care

Superior capsule reconstruction is usually performed as an outpatient procedure. Your doctor will prescribe medication to reduce post-surgical pain and inflammation. You will have encouraged to gradually move your affected arm. For the first few weeks after the surgery, you will be instructed to avoid:

• Lifting heavy objects
• Driving
• Excessive working on the computer

Rehabilitation will be initiated in phases to include certain exercises that will help heal the shoulder, lower muscle stiffness, and spasms, strengthen, improve range of motion, and return to work and sports activities.

Advantages & disadvantages

The advantages of superior capsule reconstruction are:

• Shoulder stability is restored by structurally replacing the superior capsule of the shoulder.
• Improved flexibility in shoulder movement
• Improved muscle strength
• No progression of arthritis
• No tears in the graft

Risks and complications

As with any surgery, Superior capsule reconstruction is associated with some complications, which may include:

• Infection
• Re-tear
• Severe stiffness
• Severe synovitis (inflammation)