AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-Manguito rotador no reparable_ Reconstruccion capsular superior-Pablo A. Narbona, MD

Manguito rotador no reparable_ Reconstruccion capsular superior-Pablo A. Narbona, MD

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This document discusses the management of massive retracted rotator cuff tears, a condition occurring in up to 12% of rotator cuff injuries. While 70-80% of massive tears can be fully repaired, 20-30% remain partially repaired or irreparable, defined by poor tendon quality, limited mobility after interval release, fatty infiltration (stage III-IV on MRI), and associated poor prognostic factors.<br /><br />Treatment options for irreparable tears include debridement, tenotomy, partial repair, tissue graft bridges, latissimus dorsi transfers, superior capsule reconstruction (SCR), and reverse shoulder arthroplasty reserved for cases with associated arthropathy.<br /><br />Partial repairs aim to restore force couples and biomechanics, but biological augmentation through grafts—autografts, allografts, xenografts, or synthetic matrices—is increasingly favored. Augmentation can reinforce reparable tears or serve as an interpositional bridge in irreparable tears. The superior capsule reconstruction (SCR), notably described by Mihata in 2012, restores shoulder biomechanics by reconstructing the superior capsule between the glenoid and rotator cuff footprint, controlling superior humeral head migration, and restoring the fulcrum effect.<br /><br />Originally using autologous fascia lata grafts, dermal allografts are now popular due to lower morbidity and operative time. The surgical technique involves debridement, mobilization of residual cuff, biological preparation of the glenoid and footprint, graft sizing and fixation with knotless anchors, and side-to-side suturing to the remaining cuff for stability and vascularization.<br /><br />Clinical studies show SCR achieves good outcomes in Hamada stage I-II patients, moderate results in stage III, and poor results in stage IV. Ideal candidates have massive, irreparable tears with an intact or reparable subscapularis, functioning deltoid and trapezius, and minimal glenohumeral arthritis.<br /><br />Recent literature reports improvements in acromiohumeral distance, functional scores, and graft healing rates between 45-83%. SCR is positioned as a biological alternative to reverse arthroplasty, aiming to restore stable biomechanics and convert anatomically deficient shoulders into biomechanically stable joints to improve clinical outcomes.

Keywords

massive retracted rotator cuff tears

irreparable rotator cuff tears

superior capsule reconstruction

SCR surgical technique

biological augmentation

graft types in rotator cuff repair

rotator cuff biomechanics

reverse shoulder arthroplasty

clinical outcomes of SCR

Hamada classification