The rotator cuff is a group of four muscles that run from the scapula (shoulder blade) and attach to the humeral head (top of the upper arm bone) by their tendons. The rotator cuff helps stabilize the shoulder in the socket during movement.
When a rotator cuff tear is left untreated for an extended period of time, the tendon may retract from its attachment and the muscle may atrophy and degenerate. In some cases, the chronic tear becomes irreparable. Treatment options may include living with the deficit, muscle transfers, reverse shoulder replacement, or reconstruction of the torn rotator cuff.
In specific cases, the superior capsule of the glenohumeral (shoulder) joint can be reconstructed using an iliotibial band tendon autograft from the patient’s thigh or a dermal allograft from donor tissue.
What Is Superior Capsular Reconstruction?
Superior capsular reconstruction is a procedure that may be used for certain chronic, irreparable rotator cuff tears.
A graft is placed across the top of the glenohumeral joint from the glenoid (socket) to the humerus (upper arm bone) and secured with sutures and anchors. The graft helps resist upward movement of the humerus and better maintain the central fulcrum of the shoulder joint when the arm is raised.
Dr. Chudik can also often mobilize and reattach portions of the torn, atrophied rotator cuff to the graft in an attempt to restore some rotator cuff function.
Who Is a Candidate?
Superior capsular reconstruction may be considered in specific cases when a chronic rotator cuff tear has become irreparable.
Surgery may not be appropriate in the presence of:
- Infection
- Shoulder stiffness
- Tears involving too much of the rotator cuff, particularly the subscapularis
- Arthritis
- Poor general health that is not sufficient to proceed with surgery
- An inability or unwillingness to complete the postoperative program, including wearing a sling for six to eight weeks and participating in physical therapy
MRI is limited, and the reparability of a rotator cuff tear cannot always be completely predicted before surgery. In some cases, the tear may be larger than can be reconstructed. In other cases, the tear may be found to be repairable and a graft may not be needed.
How the Procedure Is Performed
Dr. Chudik approaches rotator cuff tears arthroscopically through small incisions called arthroscopic portals. The procedure is generally performed as outpatient surgery, allowing patients to go home the same day. General anesthesia with an interscalene block is used.
A camera is used to look inside the shoulder joint, and specialized instruments are used to identify, release, mobilize, and repair as much of the rotator cuff as possible.
If a large portion of the supraspinatus cannot be repaired, either an iliotibial band autograft from the thigh or a dermal allograft from donor tissue is prepared and inserted into the shoulder through the arthroscopic portals.
The graft is attached across the top of the shoulder joint from the glenoid (socket) to the humerus (upper arm bone) using sutures and anchors. When possible, portions of the irreparable rotator cuff may be mobilized and incorporated into the reconstruction in an attempt to restore some function.
Recovery and Rehabilitation
Following surgery:
- A sling is worn at all times except for bathing, dressing, and exercises for six to eight weeks, including while sleeping.
- The repaired shoulder should not be actively moved using its own shoulder muscles for at least six to eight weeks to protect the repair and allow healing.
- Elbow motion may also be restricted if the biceps tendon is involved.
- Patients may feel more comfortable sleeping upright on a couch or recliner after surgery.
- Following arthroscopic surgery, the wound should remain clean and dry for three days.
- Driving may resume after six to eight weeks when out of the sling.
- Patients may return to school or sedentary work in less than one to two weeks as long as the arm remains in the sling and is not used.
- Physical therapy should begin two to three days after surgery and continue for four to six months.
The graft and rotator cuff gradually heal over approximately four to six months, but full rehabilitation may require six to 12 months.
Patients may return to unlimited activities when there is no pain and full shoulder range of motion, muscle strength and endurance, and functional use have been restored. This usually requires six months to one year following superior capsular reconstruction. Dr. Chudik will determine when it is safe to resume activities and has special protocols for returning to golf.
Risks and Outcomes
Potential surgical risks and complications include:
- Infection
- Rare injury to nerves of the shoulder and arm, which may cause numbness, weakness, or paralysis
- Continued or recurrent pain
- Re-tear of the rotator cuff tendon or graft
- Stiffness or loss of shoulder motion
- Inability to return to the same level of athletics or work
- Persistent shoulder weakness
- Late acromioclavicular (AC) joint pain
- Finding a tear at surgery that is larger than can be reconstructed
- Finding damage to other structures, such as the biceps tendon, labrum, or articular cartilage, that may require additional treatment during surgery
- Detachment of the deltoid muscle if open surgery is performed; Dr. Chudik performs this procedure arthroscopically
In some cases, the torn rotator cuff can be mobilized and incorporated into the graft reconstruction in an attempt to restore some of its function.
Why Dr. Chudik for Superior Capsular Reconstruction
Dr. Chudik treats the full spectrum of rotator cuff pathology, including the massive irreparable tears for which SCR is indicated.