What is Superior Capsular Reconstruction?
The anatomy of the shoulder is complex and composed of a number of ligaments, tendons and muscles that allow a wide range of motion. In particular, the rotator cuff is a sophisticated structure within the shoulder joint composed of four muscle-tendon units that greatly contribute to the shoulder’s combination of outstanding strength and wide range of motion. When the rotator cuff tendon tears due to an injury, in most cases due to a sporting activity or automobile accident, the function of the shoulder joint will be severely impaired. In some cases, an “irreparable” rotator cuff tear may occur due to a traumatic event and will lead to total impairment and inability to properly use the shoulder. Dr. Matthew Provencher, orthopedic shoulder surgeon serving patients in the Vail, Aspen, Colorado Springs, and Denver, Colorado communities, is highly experienced at Superior Capsular Reconstruction, an innovate, recently developed technique to salvage the shoulder in the setting of an “irreparable” rotator cuff tear.
The rotator cuff contains four muscle-tendon units, including the subscapularis, supraspinatus, infraspinatus and teres minor, designed to keep the head of the humerus (upper arm bone) concentric within the glenoid (shallow socket in the shoulder blade). When one of these four tendons tears from the attachment site during a traumatic event, the tear causes pain and limited joint function.
How to Fix an “Irreparable” Rotator Cuff Tear?
An “irreparable” rotator cuff tear is characterized as a tear that does not allow the tendon to be pulled back to its original attachment site. Moreover, an “irreparable” tear is also characterized by distinct fattiness and atrophy of the muscle attached to the tendon resulting in a stiff muscle that cannot properly contract.
In the case of an “irreparable” tear, Dr. Provencher may suggest this fairly new rotator cuff surgery technique, known as Superior Capsular Reconstruction. Ultimately, these patients will not benefit from traditional rotator cuff repair procedure and must seek an alternative treatment option. Superior Capsular Reconstruction was originally introduced in 2007 as a treatment option designed for patients suffering from an “irreparable” rotator cuff tear without any sign of osteoarthritis.
The goal of this technique is to reconstruct the superior capsule, the upper portion of the shoulder joint’s capsular lining, through use of a thick dermal patch. Through shoulder arthroscopy, the dermal patch is introduced into the shoulder joint, and then attached to the head of the humerus on one side and the top of the glenoid on the other side, as well as to the front and back of the rotator cuff tendons. This has been proven to provide substantial improvement in pain and function of the shoulder in patients with an “irreparable” rotator cuff tear.