Superior Capsular Reconstruction (SCR)
One of the most difficult problems to treat in the shoulder is the unrepairable rotator cuff tear. The rotator cuff is composed of four muscles that normally work together to rotate the shoulder and raise the arm. They keep the ball centered in the socket and provide stability to the joint. When a tear in the rotator cuff occurs, particularly a large tear where two or more tendons are torn, the ball will start to ride high in the socket and impinge on the bone above, causing pain. The normal mechanical leverage of having the ball in the socket is lost, and raising the arm becomes difficult and sometimes impossible for the patient.
Rotator cuff tears can often be repaired surgically, but occasionally they are not repairable. Tears can be unrepairable because they are too large or because they are chronic, old tears that are retracted and the muscle has atrophied and been replaced by fat. In the past, the only treatment options for unrepairable rotator cuff tears were cortisone injections, anti-inflammatory medications, physical therapy, and occasionally, cleaning out the joint with arthroscopic surgery. These treatments are helpful, but patients often continue to have significant pain and disability.
Reverse total shoulder replacement is a newer treatment option for unrepairable rotator cuff tears and involves replacing the joint. This surgery was initially intended for older patients, but is being used in younger patients as well. There are still serious concerns about how durable and how long a reverse shoulder replacement will last. Because of this, is best used in patients who are older, have arthritis, and have low functional demands.
It is preferable to preserve the patient’s own joint, especially in younger, more active patients who do not have arthritis. Superior capsular reconstruction was developed as a way to treat younger patients who have an unrepairable rotator cuff tear without having to do a reverse total shoulder joint replacement. The surgery uses a graft of cadaver tissue or tissue harvested from the thigh that is very thick and tough to recreate the ligaments over the top of the shoulder. This keeps the ball down in the socket to prevent it from sliding upwards and impinging on the bone above. It also helps to restore the normal mechanics of the ball in the socket joint and improves the ability to raise the arm. There is still some weakness because the rotator cuff muscles are not yet repaired, but most patients see a significant improvement in function. One recent study showed improvement in pain and increased the ability to raise the arm by 55 degrees and rotate outward by 15 degrees.
Superior capsular reconstruction is a new technique, but is shows promise in helping patients with a very difficult problem. Early studies show good results, but further study is needed to determine the long-term outcomes and further refine indications and techniques of this procedure.
To learn more superior capsular reconstruction, schedule an appointment with one of our joint preservation surgeons by calling 888-660-2663 or complete the appointment request box.