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Superior Capsular Reconstruction of the Shoulder

      For irreparable rotator cuff tears, superior capsular reconstruction (SCR) has become an option for restoring glenohumeral joint stability and reversing proximal humeral migration. Signs of irreparable rotator cuff tears include pain from subacromial impingement, muscle weakness, and pseudoparalysis. In biomechanical studies, Mihata et al. showed SCR with fascia lata graft and side-to-side suturing to remaining infraspinatus tendon restored superior stability of the shoulder joint. Adding acromioplasty decreased the subacromial contact area without altering the humeral head position, superior translation, or subacromial peak contact pressure. The same research group showed that using an 8-mm thick fascia lata graft attached at 15° to 45° of shoulder abduction optimized superior stability of the shoulder joint. Adams et al. performed SCR using a dermal allograft and found that greater glenohumeral abduction angle (60°) decreased applied deltoid force. SCR can be performed with the patient in the lateral decubitus or beach chair position. Arthroscopic exploration, debridement, and infraspinatus and supraspinatus repair attempt is completed before proceeding with SCR. To restore the superior capsule of the shoulder, the graft (fascia lata autograft, dermal allograft) can be attached to the superior glenoid medially and the rotator cuff footprint on the greater tuberosity of the humerus laterally, after debriding bone to enhance healing. SCR with side-to-side suturing to the remnant rotator cuff yields promising clinical results. Using a fascia lata autograft, Mihata et al. showed a reversal of pseudoparalysis in 93% to 96% of patients and mean active elevation, external rotation, and acromiohumeral distance on radiography all improved. Using a dermal allograft and a unique graft delivery technique, Burkhart et al. reversed pseudoparalysis in 9 of 10 patients and 70% of patients had completely intact grafts. Recommendations for rehabilitation and return to activity vary, but adequate time for graft healing is recommended.
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      Bibliography

        • Adams C.R.
        • Comer B.
        • Scheiderer B.
        • et al.
        The effect of glenohumeral fixation angle on deltoid function during superior capsule reconstruction: A biomechanical investigation.
        Arthroscopy. 2020; 36: 400-408
        • Adams C.R.
        • Denard P.J.
        • Brady P.C.
        • Hartzler R.U.
        • Burkhart S.S.
        The arthroscopic superior capsular reconstruction.
        Am J Orthop. 2016; 45: 320-324
        • Burkhart S.S.
        • Hartzler R.U.
        Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis.
        Arthroscopy. 2019; 35: 22-28
        • Mihata T.
        • Lee T.Q.
        • Hasegawa A.
        • et al.
        Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
        Am J Sports Med. 2018; 46: 2707-2716
        • Mihata T.
        • Lee T.Q.
        • Watanabe C.
        • et al.
        Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
        Arthroscopy. 2013; 29: 459-470
        • Mihata T.
        • McGarry M.H.
        • Kahn T.
        • et al.
        Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears.
        Arthroscopy. 2016; 32: 418-426
        • Mihata T.
        • McGarry M.H.
        • Kahn T.
        • et al.
        Biomechanical effects of acromioplasty on superior capsule reconstruction for irreparable supraspinatus tendon tears.
        Am J Sports Med. 2016; 44: 191-197
        • Mihata T.
        • McGarry M.H.
        • Pirolo J.M.
        • Kinoshita M.
        • Lee T.Q.
        Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: A biomechanical cadaveric study.
        Am J Sports Med. 2012; 40: 2248-2255