Superior Capsular Reconstruction

Superior capsular reconstruction is a procedure in which a human dermal (cadaver skin) allograft is used to reconstruct an irreparable rotator cuff. The skin graft is usually placed arthroscopically by anchoring the graft to the glenoid (socket) and greater tuberosity at the top of the humerus (upper arm bone). The skin graft is acellular and acts as a collagen scaffold. The patient’s stem cells grow into the graft and eventually the graft becomes living tissue populated by the patient’s own cells.

Placement of the graft keeps the humeral head centered on the glenoid allowing for the normal fulcrum to occur during shoulder range of motion. The graft also helps prevent the development of a specific type of arthritis called rotator cuff arthropathy in which the humeral head starts to rub on the undersurface of the acromion. Inferior results with this procedure have been observed when patients develop these adaptive changes.

  • Procedure

  • Why Superior Capsular Reconstruction

  • Candidates

  • Recovery


This procedure is done arthroscopically through 3-4 small incisions (roughly 0.5 in each) around the shoulder joint. The small portals allow a camera to enter the joint for visualization of anatomic structures, as well as tools to repair any injured structures. If the rotator cuff is irreparable due to retraction and/or scarring of the tendons, the superior capsular reconstruction is performed.

 The top of the glenoid (shoulder socket) and the greater tuberosity (normal attachment site of the rotator cuff on the upper arm) are roughened with a burr to create bleeding bone. This releases stem cells from the bone that augments healing of the graft. A cadaver (allograft) skin graft is introduced into the shoulder through one of the incisions and secured to the glenoid and greater tuberosity with small anchors (a few millimeters in size) that are inserted into the bone. These anchors contain sutures that are passed through the graft securing it to the bone. The graft is often sewed to adjacent muscle to secure the graft.

 The arm is placed into a sling. The surgery usually performed with a nerve block and heavy sedation.

  • This surgery is usually outpatient, which means the patient will be able to go home the same day.
  • Surgery typically lasts 2-2.5 hours.
  • Patients will be fit for a sling at a preoperative appointment and this sling will be placed on the patient prior to waking up from anesthesia.
  • The sling is to be worn at all times until the nerve block has worn off. At that point, the arm should be removed from the sling at least three times a day for elbow, wrist, and finger motion.
  • The incisions will be closed with absorbable sutures and covered with dressings that can usually be removed 2 days after surgery.

Frequently Asked


How long will I need to wear my sling?

6 weeks. The sling should be removed at least 3x/day for elbow, wrist, and finger range of motion exercises as will be instructed. You should do pendulum exercises 3x/day as well.

Can I drive with a sling on?

Driving with a sling is considered driving impaired and could be subject to a citation.

Do I have to wear the sling at night?

Yes. You are also usually unaware of their arm movements at night. The sling helps to ensure that the arm stays in a good position for healing.

When do I start PT after surgery?

Physical therapy typically starts 4 weeks after surgery.

When can I shower?

2 days after surgery. Once you remove the bandages, you will see 3 sticky white strips covering the wounds. These are called steri-strips and should be left in place until your first postoperative appointment.

How often do I need to use the ice machine?

The ice machine should be used for about 30 minutes at least 3 times a day until your first postop. You may ice more frequently if desired.

What is a nerve block?

An anesthetic injection performed by the anesthesiologist to turn off pain signals that go to a targeted region.

How can I control my pain after surgery?

This will be discussed at your preop appointment. If a narcotic is prescribed, the risks and side effects will be reviewed with you. We encourage you to try and discontinue these by your first postop appointment. Depending on your health history, it is encouraged to take anti-inflammatories and Tylenol instead of the narcotics.

What are the risks of an AC repair/reconstruction procedure?

The most common risk after this surgery is persistent weakness and limited range of motion; however, most patients are able to recover functional range of motion that does not limit them. Other less common risks include graft failure, infection, bleeding, arthritis, fracture, and nerve injury.

I am told I need surgery. What next?