A Lasso-Loop Traction Technique for Arthroscopic Superior Capsular Reconstruction

Abstract

Irreparable rotator cuff tears (RCTs) cause shoulder pain and disfunction. Management of RCT patients has classically been difficult due to few treatment options. Since Mihata et al. in 2013 introduced the superior capsular reconstruction (SCR) technique as a treatment option, it has become widespread among surgeons, especially for young active patients in whom reverse shoulder arthroplasty is not recommended. With SCR, a reduced humeral head can be maintained and superior displacement is avoided, improving shoulder pain and restoring active shoulder motion. A variety of grafts may be used, but the surgery can be technically complicated. An arthroscopic lasso-loop traction technique for SCR is described here, which simplifies graft shoulder reduction by traction from the anteromedial and posteromedial portals.

Advancement in Arthroscopic Superior Capsular Reconstruction for Irreparable Massive Rotator Cuff Tear

“…The Snaked Technique Kim et al 53 described a modified technique for ASCR using biceps to preserve the LHBT anchors to the glenoid labrum (the snake technique). The indications for this technique concluded a good quality of the LHBT (normal or 20% partial tear) and minimal to no glenohumeral arthritis.…”

“…One suture anchor was inserted approximately in the middle of greater tuberosity, passing all the sutures through intact LHBT using a suture passer and performing a “lasso‐loop” 53 configuration. With the aid of the radiofrequency cautery device, the biceps tendon was dissected and tenotomized approximately at the middle of the bicipital groove.…”

“…Then it came down to the fixation of LHBT, after anchor insertion at the lateral aspect of footprint, a suture hook preloaded with No. 1 PDS (Ethicon) was introduced through the anterior portal to make a lasso‐loop tie 53 and then passing it through the body of the LHBT. Later, another anchor was inserted at the junction of joint cartilage and the footprint, one lasso‐loop tie and two wrap‐around ties were made for the medial fixation of LHBT.…”