Quantitative and Computed Tomography Anatomic Analysis of Glenoid Fixation for Superior Capsule Reconstruction: A Cadaveric Study

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Superior capsule reconstruction (SCR) has recently been introduced as a treatment for massive, irreparable rotator cuff tears. This procedure has gained increasing popularity because clinical and biomechanical studies have shown that SCR is a reliable and effective treatment. Further development of the surgical technique has involved modified fixation methods on the superior glenoid with the usage of 3 or more suture anchors. Although the anatomy of the greater tuberosity and lateral fixation techniques have been studied extensively, less is known regarding medial (glenoid) fixation techniques and exact anchor placement sites on the superior glenoid for SCR. Specifically, it remains unclear if several anchors can be placed without their intraosseous trajectories interfering, and if the superior glenoid provides sufficient bone stock to place larger salvage anchors.

Previous investigations have shown the anatomic relation between the course of the suprascapular nerve (SSN) and suture anchor placement on the glenoid rim for labral repair techniques and the Nevasier portal for acromioclavicular joint resection. These studies have reported that inserting superior and posterior suture anchors introduces a potential risk of damaging the SSN. For SCR, anchor placement on the superior glenoid is further medial, and it therefore remains unclear if the suggested safe distance of 1 cm to the SSN12 is invaded.

The primary purpose of this study was to investigate glenoid fixation for SCR and evaluate anchor positions, intraosseous trajectories, and proximity to the SSN and the glenoid fossa. The secondary purpose was to provide technical pearls and pitfalls for anchor insertion on the superior glenoid during SCR. The hypotheses of this study were that the superior glenoid would provide sufficient bone stock for insertion of 3 anchors and that glenoid fixation would not endanger the safe zone of 1.0 cm to the SSN.

Full Article: Quantitative and Computed Tomography Anatomic Analysis of Glenoid Fixation for Superior Capsule Reconstruction: A Cadaveric Study