Superior Capsular Reconstruction
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Superior Capsular Reconstruction Surgical Technique

Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears Introduction The most common signs of irreparable rotator cuff tears are pain from subacromial impingement, muscle weakness in the shoulder joint, and as a result, limitation of arm elevation. These signs result mainly from a loss of the superior stability of the glenohumeral joint because of dysfunction of the rotator cuff muscles. Patients with irreparable rotator cuff tears also have a defect of the superior capsule, which is located on the inferior surface of the supraspinatus and infraspinatus tendons. The...

Positioning Surgeon preference will dictate patient positioning. Beach Chair: Position the arm in neutral abduction, flexion and rotation to help correctly set the graft tension. Lateral Decubitus: Position the arm in 15 - 30 degrees of abduction. Tissue/Bone Prep The subacromial bursa, degenerative tissues, and sutures from previous repairs must be thoroughly excised to provide a clean and clear arthroscopic view of the glenoid and humeral footprint. The glenoid and tuberosity bone beds are prepared and the PowerPick drill tip can be used to maximize vascular channels. Biceps tenodesis is...

Graft Measurement Preparation There are four critical dimensions measured between the anchors using an arthroscopic measurement probe: X1: Anterior-posterior distance between glenoid anchors Y1: Medial-lateral distance between posterior anchors X2: Anterior-posterior distance between tuberosity anchors Y2: Medial-lateral distance between anterior anchors Graft Sizing Recommendations ■■Extend the graft length at least 5 mm around the anchors to prevent the suture from cutting through. ■■Extend the graft length about 10 - 15 mm on the tuberosity side for footprint coverage. Graft Preparation...

Use a double-pulley knot configuration to help maneuver the graft onto the glenoid. Tie one suture from each SutureTak anchor together with a static surgeon’s knot over a rigid instrument. Cut the limbs from the tied sutures. Align and orientate the prepared graft in its implanted position outside a lateral 10 mm PassPort Button Cannula. Use a SutureTape retriever to carefully pull the FiberTape sutures through the PassPort Button Cannula and then through the appropriate punched holes in the graft. Retrieve and pass the four separate SutureTak sutures with a Scorpion suture passer for the...

8 Graft Positioning Pull the slack suture through the graft from the FiberTape and FiberWire sutures. Continue to pull the FiberWire suture until the graft is positioned over the SutureTak anchors firmly onto the glenoid. 9 Glenoid Graft Fixation With the graft in place, the sutures may be tied over the graft with a static surgeon’s knot. Additional fixation can be achieved using A/P knotless 2.9 mm PushLock anchors or 3.5 mm SwiveLock anchors with cinch stitches. 10 Humeral Fixation Tension the FiberTape sutures while pushing down on the graft to be sure all suture slack is removed from...

11 Margin Convergence Pass 2 - 3 margin convergence stitches to the remaining infraspinatus with a lasso or Scorpion suture passer. Careful attention should be paid to not overtighten the anterior aspect to help avoid shoulder contracture after surgery. Over-constraining the anterior graft may result in decreased rotational motion and increased risk of graft or tissue failure. Anterior graft attachment may not be necessary.1 1. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T,...

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