Arthroscopic superior capsular reconstruction with graft and use of BMAC (for Massive Rotator cuff tears or revision)
What is Superior Capsular Reconstruction?
Superior capsular reconstruction is an advanced surgical procedure to repair a massive rotator cuff repair. The procedure can be performed arthroscopically through tiny incisions. The surgery involves use of a graft and augmented with bone marrow aspirate concentrate (BMAC)
Indications for Superior Capsular Reconstruction with graft and use of BMAC
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 procedure
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 graft may be extracted from your 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.
During the procedure, BMAC (bone marrow aspirate concentrate) may be obtained from the patient and placed in the repair construct to augment the procedure and improve healing of the tendon. Once the procedure is complete, the skin incisions are closed.
Post-Operative Care after Superior Capsular Reconstruction
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
- 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.
Samuel J. Mease, M.D., Nancy J. Moontasri, M.D., Jennifer Kurowicki, M.D., Charles L. Long, M.D., Erica S. Simone, M.S., A.T.C., O.T.C., and Anthony J. Scillia, M.D.
Abstract: Superior capsular reconstruction (SCR) has become an increasingly popular choice in the treatment of massive, irreparable rotator cuff tears, pseudoparalysis, and in cases in which revision of previous rotator cuff repair is indicated. The SCR procedure is intended to restore the superior stabilizing forces of a deficient rotator cuff. This technique is accomplished by substituting an autograft or allograft between the superior glenoid and the greater tuberosity of the humerus, thus keeping the humeral head centered in the glenoid during shoulder forward flexion and abduction. Since its advent, numerous techniques have been described for this procedure. A fascia lata autograft was initially described; however, many surgeons in the United States have advocated for the use of a humeral dermal allograft. Yet, biomechanical studies have demonstrated elongation and thinning of this material. Thus, the Achilles tendon allograft may be an attractive choice for SCR, given its previous success with ligamentous and tendinous reconstructions. In this article, we present our technique of SCR using an Achilles tendon allograft.