Superior Capsular Reconstruction (SCR)
Lennard Funk & Phoebe Linton
What is the SCR?
The superior capsule is the upper part of the capsular lining of your shoulder joint. It has been shown to have a useful role in helping centre the humeral head on the glenoid socket and thereby assisting with elevation of your arm. This is a role normally played by your supraspinatus rotator cuff tendon. When the supraspinatus tendon has failed or torn beyond repair, reconstructing the superior capsule has been shown to be a useful surgical procedure. The procedure was developed by Dr Teruhisa Mihata in Japan, who has refined the technique in such a way that many shoulder surgeons around the world can successfully and reliably perform this very complex operation.
Will I benefit from SCR?
After spending some time with Dr Mihata in Japan, I feel that there is a very limited and specific indication for the SCR. The indications for a successful SCR are:
- Massive irreparable superior rotator cuff tear
- Intact posterior (infraspinatus) and anterior (subscapularis) muscle-tendons
- No arthritis
- Failed deltoid rehabilitation
What does SCR involve?
It is done through keyhole surgery, usually as a daycare procedure.
First, your surgeon will fix any repairable damage. They will then use a thick patch, designed to mimic your superior capsule, and attach this to the humeral head on one side and the top of the glenoid on the other side, as well as the rotator cuff tendons at the back and front. In this way restoring stability and improved function to your shoulder.
What is the patch?
The patch that is used is usually a dermal allograft, although Dr Mihata’s original patch was a tendon taken from the patient’s own thigh (fascia lata autograft). I personally prefer the Arthrex Allograft or Graftjacket Maxforce currently with equivalent results. To read more see here.
What are the benefits?
For the right patients, the published results are over 80% improvement in strength, pain relief and function. However, it can take up to one year to achieve the maximum benefit. Good post-operative rehabilitation is essential.
What are the risks?
The risks are very similar to rotator cuff repair surgery. Please discuss with your surgeon.
Presentation describing the history, biomechanics, and technique for the superior capsular reconstruction for massive, irreparable rotator cuff tears:
Surgical Technique for SCR: