Superior Capsule Reconstruction

Introduction

The shoulder joint is stabilized by the joint capsule and rotator cuff. Tears to the rotator cuff can cause severe pain and impairment. When defects in the underlying upper joint capsule add to the instability caused by rotator cuff tears, it cannot be repaired with conventional treatments. Superior capsular reconstruction is a surgical procedure performed to restore shoulder stability in irreparable rotator cuff tears.

Disease Overview

The shoulder is made up of the humerus (upper arm bone), scapula (shoulder blade) and the clavicle (collarbone). The articulation between these bones to move the shoulder in all possible directions is supported by a group of four muscles called the rotator cuff, which surround the shoulder joint.

A fall on an outstretched arm, repetitive stress, abnormal bone growth or a sudden jerk while lifting a heavy object can cause the rotator cuff to tear. A rotator cuff tear can be treated with non-surgical or surgical repair. However, irreparable rotator cuff tears are massive tears that cannot be easily repaired. They may be asymptomatic or present with severe pain and disability.

Indications

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

• Initial attempt at repairing the tears by immobilization and soft-tissue release fails
• Arthritis of the glenohumeral joint (chondromalacia)
• Presence of sufficient amount of healthy bone to allow fixation of anchors
• Minimal migration of the humerus
• Intact teres minor and subcapsularis muscles of the rotator cuff
  

Surgical procedure

Superior capsule reconstruction can be performed through arthroscopy, a minimally invasive technique. You will be positioned in a beach chair position. The top of the glenoid and the head of the humerus are first prepared. Drill holes are created. Two suture anchors are introduced at the medial glenoid. Two anchors loaded with fiber tape are inserted into the greater tuberosity of the humerus.

The fascia lata graft is extracted from your own thigh region.

The spaces between these anchors are measured and a graft prepared according to size. The sutures are extracted through the incision and threaded through corresponding holes that are created in the graft.

The graft is then passed through the incision and into the joint space. The sutures are pulled appropriately to accurately position the suture anchors. The sutures and fiber tape are then tied to fix the graft medially to the top of the glenoid and laterally to the greater tuberosity of the humerus head. Side-to-side sutures may also be used.

Once the procedure is complete, the skin incisions are 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 be 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 shoulder flexibility
• Improved muscle strength
• No progression of arthritis
• No tears in graft
• Improvement in night pain
• Minimal complications
  

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)