Surgical Management of Massive Irreparable Cuff Tears: Superior Capsular Reconstruction
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SURGICAL MANAGEMENT OF MASSIVE IRREPARABLE CUFF TEARS (J SANCHEZ-SOTELO, SECTION EDITOR)
Surgical Management of Massive Irreparable Cuff Tears: Superior Capsular Reconstruction Matthew P. Noyes 1 & Georges Haidamous 2 & Nicholas E. Spittle 3 & Robert U. Hartzler 4 & Patrick J. Denard 2,5
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Superior capsular reconstruction (SCR) is a surgical procedure that has been developed to provide an alternative for joint preservation in patients with massive irreparable rotator cuff tears. The purpose of this review is to assess the improvements in biomechanical properties and functional outcomes of this novel procedure. Recent Findings Biomechanically, SCR decreases superior translation and subacromial contact pressure. Glenoid fixation is maximized with three anchors, while margin convergence to any remaining rotator cuff improves stability, and findings vary based on graft type. Clinically, SCR has been associated with improvement in functional outcome in the setting of an isolated procedure, or in conjunction with rotator cuff repair. Outcomes appear to be dependent upon indications. However, in select cases, SCR may even be successful in reversing pseudoparalysis. Summary SCR seems to lead to improved biomechanics for the cuff-deficient shoulder resulting in satisfactory functional outcomes. While surgical techniques have evolved, further research is needed to optimize graft healing and longer follow-up studies are needed to continue to refine indications for SCR as a joint preservation effort in the setting of irreparable massive rotator cuff tears without arthritis. Keywords Rotator cuff: massive . Irreparable . Arthroscopic . Reconstruction . Superior capsule
Introduction Massive rotator cuff tears remain a problematic condition for the orthopaedic surgeon. The authors’ philosophy has been that joint preservation is ideal when possible—in terms of both preserving function and minimizing complications—
and therefore, we prefer joint preservation over shoulder arthroplasty whenever possible. While reverse shoulder arthroplasty has gained popularity for the treatment of irreparable rotator cuff tears without arthritis, high complication rates have been reported, in particular in younger populations [1]. Superior capsular reconstruction (SCR) provides a newer
This article is part of the Topical Collection on Surgical Management of Massive Irreparable Cuff Tears * Matthew P. Noyes [email protected] Georges Haidamous [email protected] Nicholas E. Spittle [email protected] Robert U. Hartzler [email protected] Patrick J. Denard [email protected]
1
Department of Orthopaedic Surgery, Aultman Hospital, Northeast Ohio University College of Medicine, 3684 Dressler Rd., Canton, OH 44718, USA
2
Southern Oregon Orthopaedics, Medford, OR, USA
3
Department of Orthopaedic Surgery, Aultman Hospital, Canton, OH, USA
4
The San Antonio Orthopaedic Group, San Antonio, TX, USA
5
Department of Orthopaedics and Rehabil
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