What is an arthroscopic superior capsular reconstruction (SCR)?
Superior capsular reconstruction (SCR) is a surgical technique used in patients with massive rotator cuff tears that cannot be repaired or have experienced a re-tear following their initial rotator cuff repair surgery.
The shoulder capsule is an important stabilizer of the shoulder joint. In the face of a large rotator cuff tear, the humeral head will gradually drift up and out of the socket over time. The rotator cuff helps by depressing the humeral head, and without its downward force, the upward pull of the deltoid will gradually leads to this unwanted upward migration of the humeral head. In patients that do not have sufficient rotator cuff to repair, an arthroscopic SCR can prevent superior migration of the head, and ultimately restore shoulder function and stability.
Who is a candidate for SCR?
In the past, patients with massive irreparable rotator cuff tears have been faced with very limited treatment options. Many surgeons would recommend to surgically proceed with reverse shoulder replacement. However, this operation (which was initially intended for older patients) may not be the best option in younger patients that maintain a high level of activity – especially due to the restrictions it imposes on weight and manual labor, as well as its high likelihood of requiring revision surgery in the future.
It has been shown SCR restores stability and balance to the shoulder joint, resulting in less pain and better function for patients. Dr. Potts may recommend surgery with an arthroscopic SCR in patients with the following:
- Massive rotator cuff tears with tendon retraction that cause significant pain, weakness, and complete inability to raise the arm
- Re-tear of the tendon following rotator cuff repair surgery – can occur with traumatic injuries, returning to activities too quickly, or chronic shoulder overuse
- Minimal to no arthritis of the glenohumeral joint
- Presence of sufficient amount of healthy bone to allow fixation of anchors
- Fully functioning deltoid muscle
What is the surgical technique for an arthroscopic SCR?
In patients with irreparable rotator cuff tears, Dr. Potts will perform an SCR utilizing minimally invasive shoulder arthroscopy. Patients who undergo arthroscopic SCR will have less pain and stiffness, lower risk of infection, and quicker recovery after surgery in comparison to traditional open surgery.
During this procedure, Dr. Potts uses a cadaver skin graft (called a dermal allograft) to rebuild the upper capsule of the shoulder, which has been lost due to a severe or long-standing rotator cuff tear. The graft is anchored into the top of the socket and then into the insertion of the rotator cuff. This helps reestablish the natural mechanics of the shoulder and prevents upward migration of the humeral head in the presence of a severely torn rotator cuff tendon. An SCR allows the remaining parts of the rotator cuff to continue working as normal, giving patients the ability to lift and rotate their arms with less pain and improved function.