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Review
. 2019 Jan;7(1):3-11.

Superior Capsule Reconstruction: What Do We Know?

Richard A C Dimock  1   1   2   3 , Sheraz Malik  1   1   2   3 , Paolo Consigliere  1   1   2   3 , Mohamed A Imam  1   1   2   3 , A Ali Narvani  1   1   2   3
Affiliations
Review

Superior Capsule Reconstruction: What Do We Know?

Richard A C Dimock et al. Arch Bone Jt Surg. 2019 Jan.

Abstract

The management of irreparable rotator cuff tears remains challenging. Since its introduction by Mihata in 2012, superior capsule reconstruction (SCR) has grown in popularity at an astonishingly rapid rate. The aim of this article is to provide a comprehensive review of the available literature, in order to highlight what has so far been published on SCR, covering all aspects including biomechanical, clinical and radiological studies as well as descriptions of the various techniques for performing the procedure. The short-term clinical results of SCR are promising, but there is need for further long-term studies, as well as randomised controlled trials comparing SCR to other treatment modalities for irreparable rotator cuff tears. Further imaging studies looking at graft healing rates are also required as the healing rates published so far are variable. Additionally, the mechanism of action by which SCR delivers good short-term functional outcomes needs further clarification, as does the importance of the choice of graft type and thickness.

Keywords: Irreparable rotator cuff tears; Rotator cuff tears; Superior capsule reconstruction.

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Figures

Figure 1
Figure 1
Arthroscopic view through the lateral port of right shoulder showing the repaired graft to infraspinatus remnants
Figure 2
Figure 2
Diagram demonstrating the “Pull-Over technique for SCR as described by the senior author (AN)(17). In this technique, the greater tuberosity anchors were inserted after the matrix has been pulled through to the correct position in the subacromial space so, during the passage of the graft, there were fewer sutures to deal with and therefore the risk of sutures becoming tangled was reduced
Figure 3
Figure 3
Arthroscopic view through the posterior port of right shoulder demonstrating the stabilization of the graft to the glenoid
Figure 4
Figure 4
Arthroscopic view through the posterior port of right shoulder illustrating the passing through of anchor suture limbs through the graft and the repair of the lateral end of the graft to greater tuberosity in a double row manner
Figure 5
Figure 5
Arthroscopic view through the posterior port of right shoulder showing the repaired lateral end of the graft to the greater tuberosity
Figure 6
Figure 6
Arthroscopic view through the posterior port of the mid portion of the grafting following
Figure 7a
Figure 7a
MRI images pre-surgery illustrating massive irreparable tear
Figure 7b
Figure 7b
MRI images one year following SCR showing healed graft
See this image and copyright information in PMC

References

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    1. Hirahara AM, Andersen WJ, Panero AJ. Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up. Am J Orthop. 2017;44(6):266–78. - PubMed
    1. Burkhart SS, Denard PJ, Adams CR, Brady PC, Hartzler RU. Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff repair. Arthrosc Tech. 2016;5(6):e1407–18. - PMC - PubMed
    1. Clark JM, Harryman DT 2nd. Tendons, ligaments, and capsule of the rotator cuff Gross and microscopic anatomy. J Bone Joint Am. 1992;74(5):713–25. - PubMed
    1. Nimura A, Kato A, Yamaguchi K, Mochizuki T, Okawa A, Sugaya H, et al. The superior capsule of the shoulder joint complements the insertion of the rotator cuff. J Shoulder Elbow Surg. 2012;21(7):867–72. - PubMed

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