What is Superior Capsule Reconstruction?
Superior capsule reconstruction (SCR) is a procedure that is used in the treatment of irreparable rotator cuff tears. The procedure was first described in 2013 by Dr. Teruhisa Mihata from Japan. Patch grafting has a long history of being used to “bridge gaps” in irreparable rotator cuff tears. Mihata’s innovation was attaching the graft to the glenoid or socket site of the joint as opposed to sewing the graft into soft tissue. In doing so, Mihata essentially replaced the normal ligamentous superior capsule, which provides restraint/stability to the humeral head. With a restored superior capsule, the humeral head stays centered in the socket and the remaining muscles (i.e. deltoid) can continue to move the shoulder effectively.
Biomechanical work has shown the SCR more closely restores joint stability than a patch graft. Clinically, Mihata has also reported good results in his patients. The original graft source described by Mihata was fascia harvested from patient’s hip. We have adapted the procedure and use a dermal allograft (sterilized skin graft from a cadaver). The advantage to this graft source is decreased procedure time and decreased morbidity of graft harvest. The procedure is performed arthroscopically on an outpatient basis and takes about 1 to 1.5 hours.
Schematic shows a massive rotator cuff tear.
Superior capsule reconstruction with dermal allograft. The graft spans from the glenoid or socket to the humeral head.
Our study group has a series of over 60 patients with one year follow-up using this technique and I have personally performed over 40 SCRs as of this writing which is one of the largest series in the world. In our experience, SCR can have good success for patients without another solution. However, the indication is important. That is, it isn’t for everyone. We have identified precise factors that are associated with a successful outcome, including factors such as the amount of rotator cuff remaining and the amount of arthritis.
If you have an “irreparable” rotator cuff tear, you may be a candidate for SCR as an option to avoid joint replacement and instead have a joint preservation procedure but is important the procedure is used judiciously and there is a clear understanding between the surgeon and the patient of the expectations.