Superior Capsular Reconstruction for Irreparable Massive Cuff Tear

Small full thickness rotator cuff tendon tears if not treated early, will tear further and eventually become massively torn, retracted and irreparable.

A Irreparable Massive Tear of the Supraspinatus tendon.

A massive tear of the supraspinatus tendon with retraction. It cannot be reduced to the humeral head.

The shoulder capsule is an important static stabiliser of the shoulder joint, with the anterior capsule maintaining anterior shoulder stability whereas the posterior capsule provides posterior stability.

Because the superior capsule attaches to a large area of the greater tuberosity, it is often concomitantly torn with posterosuperior rotator cuff tears.

Biomechanically, it has been shown that superior capsular defects increased shoulder translation in all directions, particularly with superior translation at 5 degrees and 30 degrees of abduction.

On the other hand, reconstruction of the superior capsule with a collagen graft, attached medially to the superior glenoid and laterally to the greater tuberosity, restored superior translation to physiological conditions in a biomechanical cadaveric model.

Superior Capsular Reconstruction

 

Prof Mihata from Japan reported clinical outcomes of 23 patients undergoing superior capsule reconstruction with a fascia lata autograft. After a minimum follow-up period of 2 years, all average clinical outcomes scores significantly improved.

The American Shoulder and Elbow Surgeons score improved from 23.5 preoperatively to 92.9 postoperatively, and shoulder muscle  strength significantly improved as well. The acromiohumeral distance significantly increased by 4.1 mm after surgery. Postoperative
magnetic resonance imaging showed that 83% of the patients had intact reconstructions and no progression of muscle atrophy. The results of Prof Mihata indicate that superior capsule reconstruction may be a promising tool to manage massive irreparable rotator
cuff tears.

Dr HC Chang performs superior capsular reconstruction surgery for massive irreparable cuff tears.

 

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