Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

Authors:

Maximilian Petri, Joshua A Greenspoon, Peter J Millett

Abstract:

Massive irreparable rotator cuff tears involving the posterosuperior rotator cuff are challenging to treat. Many treatment options exist, including debridement, partial rotator cuff repair, patch- augmented rotator cuff repair, bridging rotator cuff reconstruction with a graft, latissimus dorsi tendon transfer, and superior capsule reconstruction. If joint space narrowing with cuff tear arthropathy is present or when the subscapularis is also irreparable, reverse total shoulder arthroplasty is indicated.

The shoulder capsule is an important static stabilizer of the glenohumeral joint, with the anterior capsule maintaining anterior glenohumeral stability whereas the posterior capsule provides posterior stability. Because the superior capsule attaches to a large area of the greater tuberosity, it is often concomitantly torn with posterosuperior rotator cuff tears. Biomechanically, it has been shown that superior capsular defects increased glenohumeral translation in all directions, particularly with superior translation at 5 and 30 of 5 abduction. On the other hand, reconstruction of the superior capsule with a collagen graft, attached medially to the superior glenoid and laterally to the greater tuberosity, restored superior translation to physiological conditions in a biomechanical cadaveric model.

One study has reported on clinical outcomes after superior capsule reconstruction. Mihata reported clinical outcomes of 23 patients undergoing superior capsule reconstruction with a fascia lata autograft. After a minimum follow-up period of 2 years, all average clinical outcomes scores significantly improved. The American Shoulder and Elbow Surgeons score improved from 23.5 preoperatively to 92. post-operatively, and shoulder muscle strength significantly improved as well. The acromiohumeral distance significantly increased by 4.1 mm after surgery. Post-operative magnetic resonance imaging showed that 83% of the patients had intact reconstructions and no progression of muscle atrophy. The results of Mihata indicate that superior capsule reconstruction may be a promising tool to manage massive irreparable rotator cuff tears. Video 1 demonstrates our preferred technique for arthroscopic superior capsule reconstruction.

For the complete study: Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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