The rotator cuff is a muscle-tendon structure consisting of four muscles (supraspinatus, subspinatus, subscapularis, and petit rounder), whose respective tendons insert at the level of the humerus and fuse with the shoulder joint capsule (the ‘shell’ that contains this joint), ensuring, together with the deltoid muscle and the scapularis muscles, the correct movement of the shoulder joint (Fig. 1).

Injuries to the rotator cuff can be traumatic, i.e. due to a single traumatic event, or degenerative, as a result of repeated microtraumatic events and/or functional overloads characteristic of a particular athletic/work activity.

Irreparable rotator cuff injuries have long been a challenge for orthopaedic surgeons,[1].

These injuries often result in superior migration of the head of the humerus and are associated with pain and reduced range of motion.[2]

Historically, successive surgical repair techniques over the years have not yielded good clinical results. Until recently, the only alternative was an inverted shoulder prosthesis or a tranfert of the great spine, both of which are non-anatomical and invasive procedures. The innovative technique of upper capsular reconstruction under arthroscopy represents the new minimally invasive frontier in the repair of massive rotator cuff injuries,[3].

This procedure involves the use of a graft derived from fascia lata or homologous human dermis (allograft, donor tissue) that can restore the joint capsule and superior glenohumeral stability (Fig 1). The procedure can in some cases be performed using autologous long biceps tendon (only in the case of injuries that are not too large).

The procedure is performed arthroscopically, using multiple approximately 1 cm portals, in a completely minimally invasive manner[4].

Studies have shown and are increasingly demonstrating that upper capsule repair can significantly improve quality of life by improving range of motion and decreasing pain.[5]

Post-operative treatment uses a brace that immobilises the shoulder for 4-6 weeks, followed by a rehabilitation protocol to restore joint motion and muscle power with early mobilisation in water and hydrokinesiotherapy. The post-operative recovery phase lasts about 6 months in all.

  1. Superior Capsular Reconstruction for the Operatively Irreparable Rotator Cuff Tear: Clinical Outcomes Are Maintained 2 Years After Surgery.Burkhart SS, Pranckun JJ, Hartzler RU.Arthroscopy. 2020 Feb;36(2):373-380.
  2. Superior Capsular Reconstruction. Hartzler RU, Burkhart SS. Orthopedics. 2017 Oct 1;40(5):271-280.
  3. Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Repair. Burkhart SS, Denard PJ, Adams CR, Brady PC, Hartzler RU. Arthrosc Tech. 2016 Dec 12;5(6):e1407-e1418.
  4. Management of the Irreparable Rotator Cuff Tear. Cvetanovich GL, Waterman BR, Verma NN, Romeo AA. J Am Acad Orthop Surg. 2019 Dec 15;27(24):909-917.
  5. Superior Capsular Reconstruction for Massive Rotator Cuff Tear Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic Review. Sochacki KR, McCulloch PC, Lintner DM, Harris JD. Arthroscopy 2019 Apr;35(4):1269-1277.

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