Superior Capsular Reconstruction

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.

• Prevent development of rotator cuff arthropathy
• Restore shoulder range of motion and function
• Decrease/eliminate catching or popping in the shoulder
• Return to work, sport, and activities with confidence

• Irreparable rotator cuff in young patient
• No upward shift (superior migration) of the humeral head
• No significant arthritis
• Patients are generally younger than 65 years old
• Intact subscapularis (main rotator cuff muscle in the front of the shoulder)

Patients are usually placed in a sling for 6 weeks postop. The sling may be removed for elbow, wrist, and finger movement by the first day after surgery. Physical therapy (PT) will start 4 weeks after surgery. Physical therapists follow a prescribed protocol outlined by Dr. Faulkner to regain range of motion and strength. Physical therapy and home exercises are a critical part of a patient’s outcomes and quality of life after surgery. Patients should expect to continue to improve with range of motion and strength up to 9 months after surgery, with most of the gains occurring within the first 6 months. Patients should plan on being seen in clinic about every 6-8 weeks until 9 months after surgery for close monitoring and to ensure any questions are answered. Radiographs will be taken at 2 weeks and a postoperative MRI at 3 months to evaluate healing of the graft. Most patients are cleared for full activity 9 months after surgery, but it is generally recommended that patients avoid lifting more than 25 lbs overhead with the operative arm for 1 year after surgery.