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All-arthroscopic Superior Shoulder Capsule Reconstruction with Partial Rotator Cuff Repair

March 01, 2017

Contributors: Edward Sutter, MD, MS; Grant E Garrigues, MD; Jonathan Alexander Godin, MD

Introduction: Massive, irreparable rotator cuff tears are an increasingly common, and difficult to manage, clinical problem. Despite a number of described treatment options, none provides superior long-term results and there is no consensus with regard to the optimal surgical technique. Superior capsular reconstruction is an operative treatment option aimed at restoring some of the native biomechanics of the glenohumeral joint by providing a passive restraint to superior subluxation. Partial rotator cuff repair (RCR) in the setting of massive tears has also been shown to recreate shoulder kinematics and can be performed in conjunction with superior capsule reconstruction (SCR). We describe a technique for arthroscopic superior capsular reconstruction with a decellularized dermal allograft in conjunction with a concomitant partial rotator cuff repair. Methods: The patient is positioned and standard and accessory shoulder arthroscopy portals are created. Diagnostic scope is performed and supraspinatus tendon is interrogated to confirm it cannot be repaired and that the humeral head can be reduced. Partial rotator cuff repair is then performed if necessary to restore the transverse force couples of the shoulder joint. The glenoid and humerus are prepared for suture anchor fixation and anchors placed. The dimensions are measured and the dermal allograft is cut and prepared to appropriate size. The sutures are then passed through the graft and the graft prepared for insertion. The graft is then inserted into the joint and secured to the glenoid and humerus. The graft is then sutured to the intact infraspinatus posteriorly in a side-to-side fashion to complete reconstruction of the superior capsule. Results: The current video presents a new technique; we therefore currently have limited clinical follow up of our technique specifically. We will, however reference biomechanical and clinical results related to previous versions of the SCR. Discussion and Conclusion: The described superior capsular reconstruction technique using a decellularized extracellular matrix dermal allograft, in conjunction with partial rotator cuff repair, seeks to restore the glenohumeral joint superior capsule, thereby re-establishing native shoulder contact pressures and translation. This is a reproducible technique that, if performed anatomically, may also provide for more aggressive rehabilitation protocols, earlier return to activity, and delay shoulder arthropathy and reconstructive surgery.

Results for "Shoulder & Elbow"

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