Skip to main content

Advertisement

SpringerLink
Log in

Surgical Management of Massive Irreparable Cuff Tears: Superior Capsular Reconstruction

  • Surgical Management of Massive Irreparable Cuff Tears (J Sanchez-Sotelo, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Superior capsular reconstruction (SCR) is a surgical procedure that has been developed to provide an alternative for joint preservation in patients with massive irreparable rotator cuff tears. The purpose of this review is to assess the improvements in biomechanical properties and functional outcomes of this novel procedure.

Recent Findings

Biomechanically, SCR decreases superior translation and subacromial contact pressure. Glenoid fixation is maximized with three anchors, while margin convergence to any remaining rotator cuff improves stability, and findings vary based on graft type. Clinically, SCR has been associated with improvement in functional outcome in the setting of an isolated procedure, or in conjunction with rotator cuff repair. Outcomes appear to be dependent upon indications. However, in select cases, SCR may even be successful in reversing pseudoparalysis.

Summary

SCR seems to lead to improved biomechanics for the cuff-deficient shoulder resulting in satisfactory functional outcomes. While surgical techniques have evolved, further research is needed to optimize graft healing and longer follow-up studies are needed to continue to refine indications for SCR as a joint preservation effort in the setting of irreparable massive rotator cuff tears without arthritis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Sershon RA, Van Thiel GS, Lin EC, McGill KC, Cole BJ, Verma NN, et al. Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years. J Shoulder Elb Surg. 2016;23:395–400.

    Article  Google Scholar 

  2. Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med. 2012;40:2248–55.

    Article  Google Scholar 

  3. Mihata T, Bui CNH, Akeda M, Cavagnaro MA, Kuenzler M, Peterson AB, et al. A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear. J Shoulder Elb Surg. 2017;26:2158–66.

    Article  Google Scholar 

  4. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ. Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears. Arthroscopy. 2016;32:418–26.

    Article  Google Scholar 

  5. Schon JM, Katthagen JC, Dupre CN, Mitchell JJ, Turnbull TL, Adams CR, et al. Quantitative and computed tomography anatomic analysis of glenoid fixation for superior capsule reconstruction: a cadaveric study. Arthroscopy. 2017;33:1131–7.

    Article  Google Scholar 

  6. Pogorzelski J, Muckenhirn KJ, Mitchell JJ, Katthagen JC, Schon JM, Dahl KD, et al. Biomechical comparison of 3 glenoid-side fixation techniques for superior capsular reconstruction. Am J Sports Med. 2018;46:801–8.

    Article  Google Scholar 

  7. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ. Biomechanical role of capsular continuity in superior capsule reconstruction for irreparable tears of the supraspinatus tendon. Am J Sports Med. 2016;44:1423–30.

    Article  Google Scholar 

  8. Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, et al. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29:459–70.

    Article  Google Scholar 

  9. Hirahara AM, Andersen WJ, Panero AJ. Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up. Am J Orthop. 2017;46:266–78.

    PubMed  Google Scholar 

  10. Mihata T, Lee TQ, Fukunishi K, Itami Y, Fujisawa Y, Kawakami T, et al. Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears. Am J Sports Med. 2018;46:1077–83.

    Article  Google Scholar 

  11. Pennington WT, Bartz BA, Pauli JM, Walker CE, Schmidt W. Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: short-term clinical outcomes and the radiographic parameter of superior capsular distance. Arthrosocpy. 2018;34:1764–73.

    Article  Google Scholar 

  12. •• Denard PJ, Brady PC, Adams CR, Tokish JM, Burkhart SS. Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft. Arthroscopy. 2018;34:93–9 Largest study reporting on SCR outcomes. At 1 year, they found that the success rate was around 70% eventhough healing rates on MRI were low (45%). They were also able to clarify indications for SCR by determining that patients with adaptive changes to the humeral head and/or glenohumeral arthritis as well as those with subscapularis atrophy ≥ grade 3 had low success rates.

    Article  Google Scholar 

  13. Burkhart SS, Hartzler RU. Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis. Arthroscopy. 2019;35:22–8.

    Article  Google Scholar 

  14. Mihata T, Lee TQ, Hasegawa A, Kawakami T, Fukunishi K, Fujisawa Y, et al. Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears. Am J Sports Med. 2018;46:2707–16.

    Article  Google Scholar 

  15. Mihata T, Lee TQ, Hasegawa A, Fukunishi K, Kawakami T, Fujisawa Y, et al. Five-year follow-up of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Orthop J Sports Med. 2019;7(3_suppl2):2325967119S00194.

    Article  Google Scholar 

  16. Arrigoni P, Brady PC, Burkhart SS. The double-pulley technique for double-row rotator cuff repair. Arthroscopy. 2007;23(6):675–e1.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Aultman Hospital, Northeast Ohio University College of Medicine, 3684 Dressler Rd., Canton, OH, 44718, USA

    Matthew P. Noyes

  2. Southern Oregon Orthopaedics, Medford, OR, USA

    Georges Haidamous & Patrick J. Denard

  3. Department of Orthopaedic Surgery, Aultman Hospital, Canton, OH, USA

    Nicholas E. Spittle

  4. The San Antonio Orthopaedic Group, San Antonio, TX, USA

    Robert U. Hartzler

  5. Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA

    Patrick J. Denard

Authors
  1. Matthew P. Noyes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georges Haidamous
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas E. Spittle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert U. Hartzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick J. Denard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew P. Noyes.

Ethics declarations

Conflict of Interest

Matthew Noyes, Georges Haidamous, and Nicholas Spittle declare that they have no conflict of interest. Robert Hartzler reports he is a consultant for Arthrex and receives royalties from Lippincott, Williams, and Wilkins. Patrick Denard reports he is a consultant and receives royalties from Arthrex as well as royalties from Lippincott, Williams, and Wilkins.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Surgical Management of Massive Irreparable Cuff Tears

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Noyes, M.P., Haidamous, G., Spittle, N.E. et al. Surgical Management of Massive Irreparable Cuff Tears: Superior Capsular Reconstruction. Curr Rev Musculoskelet Med 13, 717–724 (2020). https://doi.org/10.1007/s12178-020-09669-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-020-09669-1

Keywords

Search

Navigation