Arthroscopic Superior Capsular Reconstruction
What is Arthroscopic Superior Capsular Reconstruction (SCR)?
Superior Capsular Reconstruction is a surgical procedure to repair massive, irreparable rotator cuff tears. The surgery involves reconstruction of the superior capsule of the shoulder joint using an autograft (tissue from the same person) or an allograft (tissue from a donor).
The upper part of the capsular lining of your shoulder joint is the superior capsule. A rotator cuff is a group of 4 muscles in the shoulder joint including the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles originate in the scapula and attach to the head of the humerus through tendons. The rotator cuff forms a sleeve around the humeral head and glenoid cavity, providing stability to the shoulder joint while enabling a wide range of movements.
Indications for Arthroscopic SCR
Arthroscopic SCR is indicated for massive, irreparable superior rotator cuff tears. Reconstructing the superior capsule will help restore stability to the shoulder and minimize dysfunction.
What Happens if Massive Rotator Cuff Tears are Left Untreated?
A massive rotator cuff tear is characterized by pain, increased weakness and disability. Untreated superior rotator cuff tears can cause partial dislocation of the humerus, impingement of tissues, the formation of bone spurs and osteoarthritis.
Preparing for SCR
Your doctor will review your medical history and perform a physical examination to assess pain, movement, and strength. X-rays may be performed to look at associated bone injuries or defects. MRI or CT-scan may be ordered to visualize the rotator cuff injury.
Talk to your doctor about the medicines you are taking prior to the procedure. Inform your doctor if you are allergic to any medicines or anesthesia. Be prepared for an overnight stay at the hospital and arrange for someone to drive you home the next day.
Arthroscopic SCR Procedure
Surgery is performed through arthroscopy. An arthroscope is a small, fiber-optic instrument consisting of a lens, light source, and video camera. The camera projects images of the inside of the joint onto a large monitor, allowing your surgeon to look for any damage, assess the type of injury and repair it.
The surgical procedure involves the following steps:
- You will lie in a decubitus position (towards your side).
- You may be given general anesthesia and regional anesthesia.
- Your surgeon makes cutaneous marks for the incisions.
- A small incision is made on the skin near the shoulder joint.
- Arthroscopic portals are inserted.
- Partial repair of the rotator cuff is performed.
- The bones of the shoulder joint are prepared for graft placement.
- Suture anchors are placed.
- The graft is passed and secured with sutures.
- The suture strands are secured further by lateral anchors (double row technique).
- Your surgeon assures that the graft is secured to the humeral head.
- A final assessment of the shoulder is performed, and the incision is closed.
Recovery after Surgery
Your doctor will prescribe pain medicines as needed. Your shoulder is supported with a sling for about 6 weeks. Your physiotherapist will teach specific physical exercises to help you recover sooner.
Risks and Complications
As with any surgery, there are risks and complications that may occur. Those related to superior capsular reconstruction may include:
- Anesthetic complications
- Nerve damage
- Tendon re-tear
Dr. Garrigues has received special training from some of the inventors of the current SCR technique and has been performing this procedure with his own modifications since soon after its invention. His published technique combines repair of any repairable rotator cuff tendon with a sterilized, cadaver-donated skin graft to reconstruct some of the pain-relieving, and motion preserving functions of the rotator cuff.
Watch the video to see how the rotator cuff can be restored through a minimally-invasive, arthroscopic, outpatient surgery.
Dr. G was honored to be recognized as a thought leader in the field to write a commentary in the prestigious Journal of Bone and Joint Surgery, on the 5-year results published by the inventor of the procedure, Dr. Mihata from Osaka Medical College, Takatsuki, Osaka Japan.