AANA Lab Course 904 - Shoulder Superstars: Everything You Can Do in a Shoulder Through the Scope! (APEx)-Superior Capsular Reconstruction

Pdf Summary

This presentation by Dr. Jeffrey S. Abrams at the Arthroscopy Association of North America (April 2019) discusses superior capsular reconstruction (SCR) as a treatment for massive, retracted rotator cuff tears, particularly in young, active patients with minimal arthritis and preserved passive shoulder motion but active functional deficits.<br /><br />Patient selection is critical, considering history (traumatic vs. atraumatic, chronicity, response to conservative treatment), physical exam findings (active vs. passive motion, scapular function, muscle atrophy), and radiographic evaluation of joint cartilage and muscle quality (atrophy, fatty infiltration). Conditions such as pseudoparalysis or paresis characterized by weakness and anterosuperior humeral head escape are important factors to assess.<br /><br />Revision options for irreparable rotator cuff tears include repeat repair, various grafts (biceps tendon, allograft, biological grafts), superior capsular reconstruction, balloon spacers, and reverse total shoulder arthroplasty. SCR aims to restore shoulder stability by stabilizing and depressing the humeral head, thus improving pain and active motion while preserving future treatment options.<br /><br />The surgical procedure involves careful time management focusing on shoulder preparation, graft preparation and insertion, and cuff incorporation. Examination under anesthesia assists in surgical planning.<br /><br />In summary, SCR is a valuable technique for irreparable rotator cuff tears, serving as a revision or salvage surgery option that can provide pain relief and gains in active shoulder motion. Proper patient selection and surgical technique are key to optimizing outcomes and enabling patients to return to physical activities.

Asset Caption

Dr. Jeffery S. Abrams, M.D.

Keywords

Superior Capsular Reconstruction

Rotator Cuff Tears

Irreparable Rotator Cuff

Patient Selection

Shoulder Stability

Revision Surgery

Graft Preparation

Shoulder Motion

Pseudoparalysis

Reverse Total Shoulder Arthroplasty