Superior Capsular Reconstruction (SCR) is a minimally invasive surgical technique used to manage massive, irreparable rotator cuff tears in the shoulder. When the rotator cuff cannot be repaired directly, SCR offers an alternative to restore function and stability. The procedure involves placing a graft—either from the patient (autograft) or a donor (allograft)—between the glenoid (shoulder socket) and the humeral head. This graft acts like a new superior capsule, preventing upward movement of the humeral head and supporting shoulder mechanics. SCR is typically performed arthroscopically (via keyhole surgery), often as a day procedure. The surgeon first addresses any repairable shoulder damage, then fixes the graft in place to mimic the natural constraint of the superior capsule. Outcomes from SCR have been promising, especially in younger or active patients with few treatment options. It helps reduce pain and restore range of motion, potentially delaying or avoiding the need for shoulder replacement.

What is Superior Capsular Reconstruction?

The shoulder is a complex joint composed of ligaments, tendons, and muscles that enable a wide range of motion. The rotator cuff consists of four muscle-tendon units that provide strength and mobility to the shoulder. A rotator cuff tear, often caused by a sporting injury, accident, or degeneration, can significantly impair shoulder function. In severe cases, an “irreparable” rotator cuff tear may occur, leading to total impairment of shoulder movement.

Dr. Khaleel, Senior Consultant Arthroscopic Shoulder and Sports Surgeon at Kims Alshifa, Perintalmanna, Kerala, India, specializes in Superior Capsular Reconstruction (SCR), a groundbreaking technique to restore shoulder function in cases of irreparable rotator cuff tears.

Anatomy of the Rotator Cuff

The rotator cuff is composed of four key muscle-tendon units:

1. Subscapularis
2. Supraspinatus
3. Infraspinatus
4. Teres Minor

These structures ensure the humeral head (upper arm bone) remains centered within the glenoid (shoulder socket). When one or more tendons tear, it results in pain and a loss of shoulder function.

How to Fix an "Irreparable" Rotator Cuff Tear

An irreparable rotator cuff tear occurs when the tendon cannot be reattached to its original position, often accompanied by muscle atrophy and stiffness. In such cases, Dr. Khaleel may recommend Superior Capsular Reconstruction (SCR) as an alternative to traditional rotator cuff repair. This technique, introduced in 2007, is a viable option for patients without osteoarthritis but with severe cuff tears that cannot be repaired conventionally.

The Superior Capsular Reconstruction Procedure

The procedure aims to restore shoulder stability by reconstructing the superior capsule, the upper portion of the shoulder joint's capsular lining, using a thick dermal graft.

1. A dermal patch is inserted arthroscopically into the shoulder joint.
2. The patch is attached to the humeral head on one side and the top of the glenoid on the other.
3. The graft is anchored to the remaining rotator cuff tendons, improving shoulder stability.

Studies have shown that SCR significantly reduces pain and enhances shoulder function in patients with irreparable rotator cuff tears.

Benefits of Superior Capsular Reconstruction

1. Pain Relief: Significant reduction or elimination of chronic shoulder pain.
2. Improved Function: Restores range of motion and shoulder strength.
3. Enhanced Stability: Prevents further dislocations and instability.
4. Minimally Invasive: Performed arthroscopically, leading to faster recovery and less post-operative discomfort.

Dr. Khaleel is highly experienced in Superior Capsular Reconstruction, providing personalized treatment plans to help patients regain shoulder stability, reduce pain, and return to their daily activities.