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.

Fig 1

After placement of 2 superior glenoid and 2 medial greater tuberosity anchors (right shoulder, beach-chair position, posterolateral viewing portal).

Fig 2

Preparation of ArthroFlex graft based on intra-articular measurements from each anchor.

Fig 3

All of the sutures from the glenoid and greater tuberosity anchors are passed through the appropriate holes in the graft (right shoulder, beach-chair position).

Fig 4

One suture limb from each glenoid anchor is tied together with the double-pulley technique (right shoulder, beach-chair position). In a similar fashion, 1 FiberWire suture limb from each greater tuberosity anchor is tied together with the double-pulley technique to aid in graft passage, positioning, and security.

Fig 5

Completed SpeedBridge component of arthroscopic superior capsular reconstruction (right shoulder, beach-chair position, posterolateral viewing portal).

Fig 6

Final reconstruction of superior capsule with anterior and posterior margin-convergence sutures between graft and native rotator interval tissue and between graft and native infraspinatus tendon, respectively (right shoulder, beach-chair position, posterolateral viewing portal).