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

Abstract

Irreparable massive rotator cuff tear (IMRCT) was one of the causes of shoulder dysfunction, despite technical improvement, the failure rate of IMRCT was still demonstrated to be high. Traditional treatments like non-surgical treatments, partial rotator cuff repair, and tendon transfers could only achieve a slight improvement. A potential cause for high failure rate was the fact that traditional treatments cannot restore the superior stability of glenohumeral joint, and thus restricted the movement of shoulder joint severely. Superior capsular reconstruction (SCR) using a variety of grafts (autograft, allograft, xenograft, or synthetic grafts) provided a promising option for IMRCT. In surgery, graft was fixed medially to superior glenoid and laterally to the footprint of humeral greater tuberosity. SCR could increase the stability of the superior glenohumeral joint, decrease the subacromial pressure and acromiohumeral distance. This review summarized the relevant literature regarding the alternative grafts, surgery indications, operative techniques and clinical outcomes of SCR. we compared the different grafts, key surgical steps, the advantages and disadvantages of different surgical methods to provide clinicians with new surgical insights into the treatments of IMRCT. In conclusion, IMRCT without severe glenohumeral arthritis was the best suitable indication for SCR. The clinical outcomes were positive in the short-term and middle-term following-up. More studies were necessary to determine long-term results of this surgical procedure.

Dynamic Superior Capsular Reconstruction for Irreparable Massive Rotator Cuff Tears: Histologic Analysis in a Rat Model and Short-term Clinical Evaluation

“…SCR effectively restores the stability of the shoulder joint and improves the clinical function of patients with IMRCT. 1,28,31,37,46 The conventional SCR not only connects the footprint of the greater tubercle and superior glenoid using a graft but also includes side-to-side suture of the residual infraspinatus tendon and anterior SSP tendon to the FL graft. 5,54 Posterior side-to-side suturing between the graft and the ISP tendons showed better shoulder stability according to the cadaveric biomechanical test.…”

“…7,8,26 SCR restores the stability of the glenohumeral joint and improves the function of the shoulder joint. 29,34 Anatomic supraspinatus (SSP) tendons can dynamically stabilize the shoulder and assist the deltoid muscle in abducting the shoulder joint. 7 However, conventional SCR does not restore the anatomy of the SSP, and incomplete dynamic function recovery after SCR still exists.…”

Shoulder surgeon techniques and preferences in treatment of massive rotator cuff tears: current practices for rotator cuff repair and superior capsule reconstruction

“… 6 , 7 , 22 Strategies for obtaining a thicker graft have been described, including folding the graft or adding two grafts, though no gold standard exists. 16 , 24 , 26 …”

Biomechanical outcomes of superior capsular reconstruction for irreparable rotator cuff tears by different graft materials-a systematic review and meta-analysis

“…The graft was utilized in this surgical surgery to adhere laterally to the larger tuberosity and medially to the superior glenoid. The graft's biomechanical function was as a static stabilizer that diminishes the pressure at the subacromial contact pressure and prevents superior translation of the humeral head ( 16 , 17 ). As a new arthroscopic technique, the selection of graft materials was disputed ( 18 – 20 ).…”