Arthroscopic Superior Capsular Reconstruction for an Irreparable Rotator Cuff Tear

Description

In this detailed surgical presentation, Dr. Alejandro Badia discusses the procedure of arthroscopic superior capsular reconstruction (SCR) for a patient with an irreparable rotator cuff tear, following failed previous surgeries. The surgical approach begins with the patient positioned in a left lateral decubitus position, ensuring appropriate traction on the arm. The joint is insufflated to visualize the glenohumeral joint, and a posterior portal is created for arthroscopic access.



Upon entering with a 4mm shoulder arthroscope, Dr. Badia notes the presence of synovitis and remnants of previous sutures from earlier repairs, leading to aggressive debridement to expose the superior glenoid. The procedure involves creating a direct lateral portal for further debridement and the placement of anchors more laterally on the glenoid to accommodate the attachment of a dermal allograft. Key steps include careful removal of previous anchors and suture materials to prepare the bone adequately for new anchor placements.



A series of anchors are strategically placed into high-quality bone areas to ensure a strong foundation for the graft. The surgeon emphasizes the importance of proper suture management and organization during the procedure to facilitate a successful surgical outcome.



Next, the dermal allograft, harvested from a human donor’s lumbar area, is meticulously cut to the required dimensions and prepared for insertion through the cannula. Special attention is given to create holes in the graft for suture passage, ensuring a robust connection to the anatomical structures. The sutures are passed through the graft using a mattress stitch technique, meticulously keeping track of the orientation to maintain proper tension and alignment.



Once secured, the graft is advanced into position against the glenoid, and the lateral row of anchors is introduced to provide further stabilization. The use of a specialized knot pusher facilitates the graft's firm attachment while ensuring that any remaining cuff material is addressed, promoting healing and stability.



The presentation concludes with critical post-operative care instructions emphasizing immobilization to prevent graft migration and promote healing, alongside the use of a sling with an abduction pillow. Dr. Badia highlights the SCR as an excellent alternative to more invasive procedures like reverse shoulder arthroplasty, showcasing a promising approach to managing irreparable rotator cuff injuries.

DOI: 10.1302/3114-230217

Specialties