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Superior Capsule Reconstruction: The US Perspective

  • Ashley J. Bassett
  • Meghan E. Bishop
  • Brandon J. Erickson
  • Anthony A. Romeo
  • Rachel M. Frank
  • Gregory L. Cvetanovich
Chapter
First Online:

Abstract

Irreparable massive rotator cuff tears in active middle-aged patients result in significant shoulder dysfunction and pose a particular challenge with regard to selection of optimal treatment. Superior capsule reconstruction (SCR) is a joint-preserving surgical option to restore glenohumeral stability and prevent superior humeral head migration, thereby improving shoulder function, lessening pain, and limiting development of rotator cuff arthropathy. Indications for SCR are irreparable supraspinatus and/or infraspinatus tears with persistent shoulder pain and/or dysfunction that have failed conservative treatment in a patient who is not an ideal candidate for arthroplasty due to age or activity level. Patients need to have relatively preserved glenohumeral cartilage, an intact or repairable subscapularis tendon, and a fully functioning deltoid muscle to be an appropriate candidate for SCR. SCR was originally described by Dr. Teruhisa Mihata using fascia lata autograft; however, in the United States and most of North America, dermal allograft is the most common graft choice. The graft is secured medially to the superior glenoid with two or three suture anchors and laterally to the tuberosity commonly using four anchors in a double row configuration. Preliminary clinical studies demonstrate significant improvement in pain, function, muscle strength, active shoulder range of motion with resolution of pseudoparalysis, normalization of the acromiohumeral interval and no rapid progression of osteoarthritis.

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References

  1. 1.
    Itoi E, Minagawa H, Sato T, Sato K, Tabata S. Isokinetic strength after tears of the supraspinatus tendon. J Bone Joint Surg Br. 1997;79(1):77–82.CrossRefGoogle Scholar
  2. 2.
    Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000;82(4):505–15.CrossRefGoogle Scholar
  3. 3.
    Paxton ES, Teefey SA, Dahiya N, Keener JD, Yamaguchi K, Galatz LM. Clinical and radiographic outcomes of failed repairs of large or massive rotator cuff tears: minimum ten-year follow-up. J Bone Joint Surg Am. 2013;95(7):627–32.CrossRefGoogle Scholar
  4. 4.
    Le BT, Wu XL, Lam PH, Murrell GA. Factors predicting rotator cuff tears: an analysis of 1000 consecutive shoulders. Am J Sports Med. 2014;42(5):1134–42.CrossRefGoogle Scholar
  5. 5.
    Bedi A, Dines J, Warren RF, Dines DM. Massive tears of the rotator cuff. J Bone Joint Surg Am. 2010;92(9):1894–908.CrossRefGoogle Scholar
  6. 6.
    Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency: a minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87(8):1697–705.PubMedGoogle Scholar
  7. 7.
    Sershon RA, Van Thiel GS, Lin EC, McGill KC, Cole BJ, Verma NN, Romeo AA, Nicholson GP. Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years. J Shoulder Elb Surg. 2014;23(3):395–400.CrossRefGoogle Scholar
  8. 8.
    Ek ET, Neukom L, Catanzaro S, Gerber C. Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years. J Shoulder Elb Surg. 2013;22(9):1199–208.CrossRefGoogle Scholar
  9. 9.
    Adams CR, Denard PJ, Brady PC, Hartzler RU, Burkhart SS. The arthroscopic superior capsular reconstruction. Am J Orthop. 2016;45(5):320–4.PubMedGoogle Scholar
  10. 10.
    Adams CR, DeMartino AM, Rego G, Denard PJ, Burkhart SS. The rotator cuff and the superior capsule: why we need both. Arthroscopy. 2016;32(12):2628–37.CrossRefGoogle Scholar
  11. 11.
    Ishihara Y, Mihata T, Tamboli M, Nguyen L, Park KJ, McGarry MH, Takai S, Lee TQ. Role of the superior shoulder capsule in passive stability of the glenohumeral joint. J Shoulder Elb Surg. 2014;23(5):642–8.CrossRefGoogle Scholar
  12. 12.
    Levine WN, Flatow EL. The pathophysiology of shoulder instability. Am J Sports Med. 2000;28(6):910–7.CrossRefGoogle Scholar
  13. 13.
    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(10):2248–55.CrossRefGoogle Scholar
  14. 14.
    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(6):1423–30.CrossRefGoogle Scholar
  15. 15.
    Frank RM, Cvetanovich G, Savin D, Romeo AA. Superior capsular reconstruction: indications, techniques, and clinical outcomes. JBJS Rev. 2018;6(7):e10.CrossRefGoogle Scholar
  16. 16.
    Gerber C, Wirth SH, Farshad M. Treatment options for massive rotator cuff tears. J Shoulder Elb Surg. 2011;20(2):S20–9.CrossRefGoogle Scholar
  17. 17.
    Walch G, Boulahia A, Calderone S, Robinson AH. The “dropping” and “hornblower’s” signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br. 1998;80:624–8.CrossRefGoogle Scholar
  18. 18.
    Gruber G, Bernhardt GA, Clar H, Zacherl M, Glehr M, Wurnig C. Measurement of the acromiohumeral interval on standardized anteroposterior radiographs: a prospective study of observer variability. J Shoulder Elb Surg. 2010;19(1):10–3.CrossRefGoogle Scholar
  19. 19.
    Hamada K, Yamanaka K, Uchiyama Y, Mikasa T, Mikasa M. A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res. 2011;469(9):2452–60.CrossRefGoogle Scholar
  20. 20.
    Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg. 1999;8(6):599–605.CrossRefGoogle Scholar
  21. 21.
    Yoo JC, Ahn JH, Yang JH, Koh KH, Choi SH, Yoon YC. Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans. Arthroscopy. 2009;25(6):573–82.CrossRefGoogle Scholar
  22. 22.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.Google Scholar
  23. 23.
    Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, Kinoshita M. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy. 2013;29(3):459–70.CrossRefGoogle Scholar
  24. 24.
    Boutsiadis A, Chen S, Jiang C, Lenoir H, Delsol P, Barth J. Long head of the biceps as a suitable available local tissue autograft for superior capsular reconstruction: “The Chinese Way”. Arthrosc Tech. 2017;6(5):e1559–66.CrossRefGoogle Scholar
  25. 25.
    Cabarcas BC, Garcia GH, Gowd AK, Liu JN, Romeo AA. Arthroscopic superior capsular reconstruction and over-the-top rotator cuff repair incorporation for treatment of massive rotator cuff tears. Arthrosc Tech. 2018;7(8):e829–37.CrossRefGoogle Scholar
  26. 26.
    Anderson S, Trenhaile S. All knot-less arthroscopic superior capsular reconstruction. Arthrosc Tech. 2018;7(8):e811–6.CrossRefGoogle Scholar
  27. 27.
    Hirahara AM, Adams CR. Arthroscopic superior capsular reconstruction for treatment of massive irreparable rotator cuff tears. Arthrosc Tech. 2015;4(6):e637–41.CrossRefGoogle Scholar
  28. 28.
    Petri M, Greenspoon JA, Millett PJ. Arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthrosc Tech. 2015;4(6):e751–5.CrossRefGoogle Scholar
  29. 29.
    Tokish JM, Beicker C. Superior capsule reconstruction technique using an acellular dermal allograft. Arthrosc Tech. 2015;4(6):e833–9.CrossRefGoogle Scholar
  30. 30.
    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.CrossRefGoogle Scholar
  31. 31.
    Pogorzelski J, DelVecchio BM, Hussain ZB, Fritz EM, Godin JA, Millett PJ. Superior capsule reconstruction for massive rotator cuff tears – key considerations for rehabilitation. Int J Sports Phys Ther. 2017;12(3):390.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Mihata T, Lee TQ, Hasegawa A, Kawakami T, Fukunishi K, Fujisawa Y, Itami Y, Ohue M, Neo M. Arthroscopic superior capsule reconstruction eliminates pseudoparalysis in patients with irreparable rotator cuff tears. Orthop J Sports Med. 2017;5(Suppl 3):2325967117S00119.PubMedCentralGoogle Scholar
  33. 33.
    Mihata T, Lee TQ, Fukunishi K, Itami Y, Fujisawa Y, Kawakami T, Ohue M, Neo M. Return to sports and physical work after arthroscopic superior capsule reconstruction among patients with irreparable rotator cuff tears. Am J Sports Med. 2018;46(5):1077–83.CrossRefGoogle Scholar
  34. 34.
    Denard PJ, Brady PC, Adams CR, Tokish JM, Burkhart SS. Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft. Arthroscopy. 2018;34(1):93–9.CrossRefGoogle Scholar
  35. 35.
    Hirahara AM, Andersen WJ, Panero AJ. Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up. Am J Sports Med. 2017;46(6):266–78.Google Scholar
  36. 36.
    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. Arthroscopy. 2018;34(6):1764–73.CrossRefGoogle Scholar
  37. 37.
    Mihata T, et al. Abstract presentation. In: AOSSM Annual Meeting, 2017.Google Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  • Ashley J. Bassett
    • 1
  • Meghan E. Bishop
    • 2
  • Brandon J. Erickson
    • 2
  • Anthony A. Romeo
    • 2
  • Rachel M. Frank
    • 3
  • Gregory L. Cvetanovich
    • 4
  1. 1.Rothman Orthopaedic InstituteThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Rothman Orthopaedic InstituteNew YorkUSA
  3. 3.Colorado UniversityBoulderUSA
  4. 4.Ohio State UniversityColumbusUSA

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