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Treatment Options for Irreparable Rotator Cuff Tears: Superior Capsule Reconstruction

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Shoulder Arthroscopy

Abstract

Superior capsule reconstruction (SCR) is a treatment option for irreparable rotator cuff tears (IRCTs), which is mainly indicated in intractable dysfunctional painful shoulders with complete passive range of motion (ROM), preserved glenohumeral joint cartilage on the anteroposterior radiograph, a supraspinatus and/or infraspinatus tendon tear retracted to the glenoid level, a positive tangent sign, and severe fatty infiltration on magnetic resonance imaging. In the original technique, an openly harvested tensor fascia lata autograft is folded and fixed to the superior glenoid rim and humeral head using an arthroscopic approach. The tenodesis effect of this superior capsular graft provides static glenohumeral stability and allows for the remaining shoulder muscles to recover forward flexion in patients with IRCTs. Promising clinical outcomes of SCR using fascia lata autograft or a human dermal allograft, and using different graft fixation techniques, with or without concomitant procedures, have been reported. In this chapter, an overview of SCR is presented, with an emphasis on the authors’ preferred arthroscopic surgical technique.

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References

  1. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19(1):116–20.

    Article  PubMed  Google Scholar 

  2. Cvetanovich GL, Gowd AK, Liu JN, Nwachukwu BU, Cabarcas BC, Cole BJ, et al. Establishing clinically significant outcome after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2019;

    Google Scholar 

  3. McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen FA. Rotator cuff repair. Am J Sports Med. 2014;43(2):491–500.

    Article  PubMed  Google Scholar 

  4. Gasbarro G, Ye J, Newsome H, Jiang K, Wright V, Vyas D, et al. Morphologic risk factors in predicting symptomatic structural failure of arthroscopic rotator cuff repairs: tear size, location, and atrophy matter. Arthroscopy. 2016;32(10):1947–52.

    Article  PubMed  Google Scholar 

  5. Le BT, Wu XL, Lam PH, Murrell GA. Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs. Am J Sports Med. 2014;42(5):1134–42.

    Article  PubMed  Google Scholar 

  6. Shin YK, Ryu KN, Park JS, Jin W, Park SY, Yoon YC. Predictive factors of retear in patients with repaired rotator cuff tear on shoulder MRI. Am J Roentgenol. 2018;210(1):134–41.

    Article  Google Scholar 

  7. Shim SB, Jeong JY, Kim JS, Yoo JC. Evaluation of risk factors for irreparable rotator cuff tear in patients older than age 70 including evaluation of radiologic factors of the shoulder. J Shoulder Elbow Surg. 2018;27(11):1932–8.

    Article  PubMed  Google Scholar 

  8. Sevivas N, Ferreira N, Andrade R, Moreira P, Portugal R, Alves D, et al. Reverse shoulder arthroplasty for irreparable massive rotator cuff tears: a systematic review with meta-analysis and meta-regression. J Shoulder Elbow Surg. 2017;26(9):e265–e77.

    Article  PubMed  Google Scholar 

  9. Altintas B, Anderson NL, Pitta R, Buckley PS, Bhatia S, Provencher MT, et al. Repair of rotator cuff tears in the elderly: does it make sense? A systematic review. Am J Sports Med. 2019:363546519834574.

    Google Scholar 

  10. Kim HM, Dahiya N, Teefey SA, Middleton WD, Stobbs G, Steger-May K, et al. Location and initiation of degenerative rotator cuff tears. J Bone Joint Surg Am. 2010;92(5):1088–96.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nimura A, Kato A, Yamaguchi K, Mochizuki T, Okawa A, Sugaya H, et al. The superior capsule of the shoulder joint complements the insertion of the rotator cuff. J Shoulder Elbow Surg. 2012;21(7):867–72.

    Article  PubMed  Google Scholar 

  12. Momma D, Nimura A, Muro S, Fujishiro H, Miyamoto T, Funakoshi T, et al. Anatomic analysis of the whole articular capsule of the shoulder joint, with reference to the capsular attachment and thickness. J Exp Orthop. 2018;5(1):16.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Clark JM, Harryman DT 2nd. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74(5):713–25.

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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(3):459–70.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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 Elbow Surg. 1999;8(6):599–605.

    Article  CAS  PubMed  Google Scholar 

  18. Ernstbrunner L, El Nashar R, Favre P, Bouaicha S, Wieser K, Gerber C. Chronic pseudoparalysis needs to be distinguished from pseudoparesis: a structural and biomechanical analysis. Am J Sports Med. 2020:363546520969858.

    Google Scholar 

  19. Takayama K, Yamada S, Kobori Y, Shiode H. Association between the postoperative condition of the subscapularis tendon and clinical outcomes after superior capsular reconstruction using autologous tensor fascia lata in patients with pseudoparalytic shoulder. Am J Sports Med. 2020;48(8):1812–7.

    Article  PubMed  Google Scholar 

  20. Mihata T, Lee TQ, Hasegawa A, Fukunishi K, Kawakami T, Fujisawa Y, et al. Arthroscopic superior capsule reconstruction for irreparable rotator cuff tears: comparison of clinical outcomes with and without subscapularis tear. Am J Sports Med. 2020;48(14):3429–38.

    Article  PubMed  Google Scholar 

  21. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res. 1990;254:92–6.

    Article  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. Gerber C, Wirth SH, Farshad M. Treatment options for massive rotator cuff tears. J Shoulder Elbow Surg. 2011;20(2):S20–S9.

    Article  PubMed  Google Scholar 

  24. Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol. 1998;33(3):163–70.

    Article  CAS  PubMed  Google Scholar 

  25. de Campos Azevedo CI, Ângelo ACLPG, Vinga S. Arthroscopic superior capsular reconstruction with a minimally invasive harvested fascia lata autograft produces good clinical results. Orthop J Sports Med. 2018;6(11)

    Google Scholar 

  26. Azevedo CIC, Ângelo ACLPG, Campos-Correia D, Delgado L, Ferreira N, Sevivas N. Clinical importance of graft integrity in arthroscopic superior capsular reconstruction using a minimally invasively harvested midthigh fascia lata autograft: 3-year clinical and magnetic resonance imaging outcomes. Am J Sports Med. 2020;48(9):2115–28.

    Article  PubMed  Google Scholar 

  27. Gilbart MK, Gerber C. Comparison of the subjective shoulder value and the constant score. J Shoulder Elbow Surg. 2007;16(6):717–21.

    Article  PubMed  Google Scholar 

  28. Lippitt S, Harryman DT, Matsen F. A pratical tool for function evaluation: the “simple shoulder test”. In: Matsen F, Fu F, Hawkins R, editors. The shoulder: a balance of mobility and stability. Rosemont: American Academy of Orthopaedic Surgeons; 1993. p. 501–18.

    Google Scholar 

  29. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–4.

    Article  Google Scholar 

  30. Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res. 1990;254:81–6.

    Article  Google Scholar 

  31. Ângelo ACLPG, de Campos Azevedo CI. Minimally invasive fascia lata harvesting in ASCR does not produce significant donor site morbidity. Knee Surg Sports Traumatol Arthrosc. 2018;

    Google Scholar 

  32. Adams CR, Denard PJ, Brady PC, Hartzler RU, Burkhart SS. The arthroscopic superior capsular reconstruction. Am J Orthop (Belle Mead NJ). 2016;45(5):320–4.

    PubMed  Google Scholar 

  33. Petri M, Greenspoon JA, Millett PJ. Arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthrosc Tech. 2015;4(6):e751–5.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hirahara AM, Adams CR. Arthroscopic superior capsular reconstruction for treatment of massive irreparable rotator cuff tears. Arthrosc Tech. 2015;4(6):e637–41.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 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–e18.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Narvani AA, Consigliere P, Polyzois I, Sarkhel T, Gupta R, Levy O. The “Pull-Over” technique for arthroscopic superior capsular reconstruction. Arthrosc Tech. 2016;5(6):e1441–e7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 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–e66.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Chillemi C, Mantovani M, Gigante A. Superior capsular reconstruction of the shoulder: the ABC (arthroscopic Biceps Chillemi) technique. Eur J Orthop Surg Traumatol. 2018;

    Google Scholar 

  39. 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(3):418–26.

    Article  PubMed  Google Scholar 

  40. Tokish JM, Beicker C. Superior capsule reconstruction technique using an acellular dermal allograft. Arthrosc Tech. 2015;4(6):e833–9.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lee S-J, Min Y-K. Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction. Knee Surg Sports Traumatol Arthrosc. 2018;

    Google Scholar 

  42. de Campos Azevedo CI, Andrade R, Leiria Pires Gago Angelo AC, Espregueira-Mendes J, Ferreira N, Sevivas N. Fascia lata autograft versus human dermal allograft in arthroscopic superior capsular reconstruction for irreparable rotator cuff tears: a systematic review of clinical outcomes. Arthroscopy. 2020;36(2):579–91 e2.

    Article  PubMed  Google Scholar 

  43. 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(5):1077–83.

    Article  PubMed  Google Scholar 

  44. Lim S, AlRamadhan H, Kwak JM, Hong H, Jeon IH. Graft tears after arthroscopic superior capsule reconstruction (ASCR): pattern of failure and its correlation with clinical outcome. Arch Orthop Trauma Surg. 2018;

    Google Scholar 

  45. 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(11):2707–16.

    Article  PubMed  Google Scholar 

  46. Hirahara AM, Andersen WJ, Panero AJ. Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up. Am J Orthop (Belle Mead NJ). 2017;46(6):266–78.

    PubMed  Google Scholar 

  47. 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;

    Google Scholar 

  48. 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(1):22–8.

    Article  PubMed  Google Scholar 

  49. Eigenschink M, Pauzenberger L, Laky B, Anderl W, Ostermann RC, Heuberer PR. Arthroscopic superior capsular reconstruction using a human dermal allograft in patients with and without preoperative pseudoparalysis. Obere Extremität. 2019;

    Google Scholar 

  50. Burkhart SS, Pranckun JJ, Hartzler RU. Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery. Arthroscopy. 2020;36(2):373–80.

    Article  PubMed  Google Scholar 

  51. Woodmass JM, Wagner ER, Borque KA, Chang MJ, Welp KM, Warner JJP. Superior capsule reconstruction using dermal allograft: early outcomes and survival. J Shoulder Elbow Surg. 2019;28(6S):S100–S9.

    Article  PubMed  Google Scholar 

  52. 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. J Bone Joint Surg Am. 2019;101(21):1921–30.

    Article  PubMed  Google Scholar 

  53. Ohta S, Komai O, Onochi Y. Outcomes of superior capsule reconstruction for massive rotator cuff tears and risk factors for postoperative retear. Arch Orthop Trauma Surg. 2020;140(10):1319–25.

    Article  PubMed  Google Scholar 

  54. Kholinne E, Kwak JM, Kim H, Koh KH, Jeon IH. Arthroscopic superior capsular reconstruction with mesh augmentation for the treatment of irreparable rotator cuff tears: a comparative study of surgical outcomes. Am J Sports Med. 2020;48(13):3328–38.

    Article  PubMed  Google Scholar 

  55. Plachel F, Klatte-Schulz F, Minkus M, Böhm E, Moroder P, Scheibel M. Biological allograft healing after superior capsule reconstruction. J Shoulder Elbow Surg. 2018;27(12):e387–e92.

    Article  PubMed  Google Scholar 

  56. Zerr J, McDermott JD, Beckmann NM, Fullick RK, Chhabra A. Case study: failure of superior capsular reconstruction using dermal allograft. Skeletal Radiol. 2017;46(11):1585–9.

    Article  CAS  PubMed  Google Scholar 

  57. Azevedo C, Ângelo AC. Arthroscopic superior capsular reconstruction or reverse total shoulder arthroplasty for irreparable bilateral rotator cuff tear: a case report. JBJS Case Connect. 2018;8(4):e96.

    Article  PubMed  Google Scholar 

  58. Mulligan A, Tytherleigh-Strong G. Heterotopic ossification after superior capsular reconstruction. J Shoulder Elbow Surg. 2018;27(12):e380–e6.

    Article  PubMed  Google Scholar 

  59. Shambaugh BC, Morales H, Ross G. Posterior interval tear after superior capsule reconstruction: a case report. J Shoulder Elbow Surg. 2018;27(7):e225–e9.

    Article  PubMed  Google Scholar 

  60. Sutter EG, Godin JA, Garrigues GE. All-arthroscopic superior shoulder capsule reconstruction with partial rotator cuff repair. Orthopedics. 2017;40(4):e735–e8.

    Article  PubMed  Google Scholar 

  61. Anderson S, Trenhaile S. All knot-less arthroscopic superior capsular reconstruction. Arthrosc Tech. 2018;7(8):e811–e6.

    Article  PubMed  PubMed Central  Google Scholar 

  62. 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–e37.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Kim YS, Lee HJ, Park I, Sung GY, Kim DJ, Kim JH. Arthroscopic in situ superior capsular reconstruction using the long head of the biceps tendon. Arthrosc Tech. 2018;7(2):e97–e103.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Laskovski JR, Boyd JA, Peterson EE, Abrams JS. Simplified technique for superior capsular reconstruction using an acellular dermal allograft. Arthrosc Tech. 2018;7(11):e1089–e95.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Milano G, Saccomanno MF, Colosio A, Adriani M, Galli S, Scaini A, et al. Arthroscopic superior capsule reconstruction with doubled autologous semitendinosus tendon graft. Arthrosc Tech. 2020;9(11):e1665–e72.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Bader DAL, Garcia JC. Pivot superior capsular reconstruction of the shoulder. Arthrosc Tech. 2020;9(6):e697–701.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Okamura K, Makihara T. Cable graft: simple superior capsule reconstruction technique for irreparable rotator cuff tear using a Teflon patch. Arthrosc Tech. 2020;9(4):e575–e80.

    Article  PubMed  PubMed Central  Google Scholar 

  68. El-shaar R, Soin S, Nicandri G, Maloney M, Voloshin I. Superior capsular reconstruction with a long head of the biceps tendon autograft: a cadaveric study. Orthop J Sports Med. 2018;6(7)

    Google Scholar 

  69. 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.

    Article  PubMed  Google Scholar 

  70. Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ. Biomechanical effects of acromioplasty on superior capsule reconstruction for irreparable supraspinatus tendon tears. Am J Sports Med. 2016;44(1):191–7.

    Article  PubMed  Google Scholar 

  71. 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 Elbow Surg. 2017;26(12):2158–66.

    Article  PubMed  Google Scholar 

  72. Singh S, Reeves J, Langohr GDG, Johnson JA, Athwal GS. The subacromial balloon spacer versus superior capsular reconstruction in the treatment of irreparable rotator cuff tears: a biomechanical assessment. Arthroscopy. 2018;

    Google Scholar 

  73. Yildiz F, Bilsel K, Pulatkan A, Kapicioglu M, Uzer G, Çetindamar T, et al. Comparison of two different superior capsule reconstruction methods in the treatment of chronic irreparable rotator cuff tears: a biomechanical and histologic study in rabbit models. J Shoulder Elbow Surg. 2018;

    Google Scholar 

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Author information

Authors and Affiliations

  1. Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

    Clara de Campos Azevedo

  2. Shoulder and Elbow Unit, Orthopaedic and Musculoskeletal Centre, Cuf Tejo Hospital, Lisbon, Portugal

    Clara de Campos Azevedo & Ana Catarina Ângelo

  3. Hospital dos SAMS de Lisboa, Lisbon, Portugal

    Ana Catarina Ângelo

Authors
  1. Clara de Campos Azevedo
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  2. Ana Catarina Ângelo
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Editors and Affiliations

  1. Department of Joint and Bone Surgery, University of Brescia, Brescia, Brescia, Italy

    Giuseppe Milano

  2. Department of Orthopaedics and Traumatology, Casa di Cura Villa Valeria, Rome, Roma, Italy

    Andrea Grasso

  3. Shoulder and Upper Limb Department, St. Luke's Hospital, Bielsko-Biała, Poland

    Roman Brzóska

  4. Department of Traumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Ladislav Kovačič

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de Campos Azevedo, C., Ângelo, A.C. (2023). Treatment Options for Irreparable Rotator Cuff Tears: Superior Capsule Reconstruction. In: Milano, G., Grasso, A., Brzóska, R., Kovačič, L. (eds) Shoulder Arthroscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-66868-9_45

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