Superior Capsule Reconstruction

Rotator cuff Surgery

Smooth and Move Procedure

Superior Capsule Reconstruction

Patients with large rotator cuff tears or previously failed rotator cuff repairs with continued shoulder symptoms have traditionally had very few options to improve their symptoms.  Until recently, there treatment options included an arthroscopic “cleanup” called the smooth and move procedure or a shoulder replacement.  Recently, surgeons in Japan discovered an alternative treatment – the superior capsule reconstruction.

What is the superior capsule reconstruction?

The superior capsule reconstruction is a minimally invasive technique where a tissue graft is used to bridge the gap on the top portion of the shoulder, where the rotator cuff was previously located.  By bridging this gap, the mechanics of the shoulder are restored to a more normal status by preventing the shoulder from drifting upwards through the rotator cuff tear.

The technique is illustrated here.

What patients are candidates for a superior capsule reconstruction?

Active patients that have large, irreparable rotator cuff tears are potential candidates for a superior capsule reconstruction.  My patients also have to have the following to be candidates for surgery:

• no arthritis
• no posterior or anterior rotator cuff tears
• failed previous physical therapy
• A non-smoker

What graft is used for a superior capsule reconstruction?

The graft choices for a superior capsule reconstruction are either a cadaver skin graft or a graft from thigh fascia.  In the United States, the graft choices are usually cadaver skin graft or cadaver thigh fascia graft, however, fascia from the patient’s own thigh is an option.

What are the benefits from a superior capsule reconstruction?

early studies have shown over 80% improvement in strength, pain relief, and function of the shoulder after a superior capsule reconstruction for the right patients.

Will I have a normal shoulder after a superior capsule reconstruction?

Unfortunately, the short answer is no.  The reason for this is because the anatomy of the shoulder continues to be disrupted due to the rotator cuff tear that is not able to be repaired.  However, patients generally have significantly improved function after the surgery.

What are the risks of a superior capsule reconstruction?

The risks of a superior capsule reconstruction are very similar to they risks of rotator cuff surgery.  These include a small risk of infection, bleeding, risk of nonhealing of the graft, and risk of anesthesia.

What are my options if I fail to improve after a superior capsule reconstruction?

Your options for a failed superior capsule reconstruction return to the previous treatment options after he failed rotator cuff repair – an arthroscopic smooth and move, or a reverse total shoulder replacement for older patients.