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Anterior Cable Reconstruction: Prioritize Rotator Cable and Tendon Cord When Considering Superior Capsular Reconstruction

  • Maxwell C. Park
    Correspondence
    Address correspondence to Maxwell C. Park, M.D., Southern California Permanente Medical Group, Kaiser Foundation Hospital, Woodland Hills Medical Center, Department of Orthopaedic Surgery, 5601 De Soto Ave., Woodland Hills, CA 91365, U.S.A.
    Affiliations
    Southern California Permanente Medical Group, Woodland Hills, California

    Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
    Search for articles by this author
  • Emma Detoc
    Affiliations
    Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
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  • Thay Q. Lee
    Affiliations
    Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
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      Abstract

      Although distinct in name, the anterior cable of the superior capsule and tendon cord of the supraspinatus are structurally one in the same at the attachment on the greater tuberosity footprint. Force transmission through both structures where they converge and interdigitate at this location is disproportionately high, which has implications on functional impact. Superior capsule reconstruction, and, specifically, the anterior cable of the superior capsule, has been shown to assist in maintaining superior stability and a functional fulcrum of the glenohumeral joint, without overconstraining range of motion. Anterior cable reconstructions have been described for specific indications, including full-thickness tears of the supraspinatus and anterior one-half of the infraspinatus. Cord-like grafts, including long head biceps tendon autografts and semitendinosus allografts, can provide relative technical ease during surgery compared to sheet-like grafts for this indication. Side-to-side sutures between anterior cable reconstruction graft and posterosuperior capsule retension the native capsule to optimize its natural functional role. Accounting for abduction and rotation at the time of fixation and employing “loop-around” fixation sutures (no sutures through the graft), are critical concepts to consider in terms of kinematics and limiting graft failure. With both the biomechanically and clinically based literature demonstrating functionality with maintenance of the superior capsule (and specifically the anterior cable of the capsule), despite rotator cuff tendon insufficiency or irreparability, the anterior cable of the superior capsule should be prioritized when considering full-thickness rotator cuff tears that naturally involve both the capsular cable and the supraspinatus tendon cord.

      Level of evidence

      Level V (expert opinion).
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