This is a keyhole operation performed under general anaesthesia and regional nerve block.
This relatively new technique was pioneered by a Japanese surgeon, Dr Mihata. It is designed for the younger patient (under 65 years) who has an irreparable rotator cuff tear and a significantly de-functioned shoulder in spite a good physiotherapy programme.
The aim of the capsular reconstruction is to rebalance your ball and socket joint of the shoulder, which has become compromised by the large rotator cuff tear. This enables you to use your deltoid muscle to move your arm more easily. It also potentially prolongs the life of your shoulder cartilage, as it helps to keep your humeral head centred in the socket during motion.
Superior capsular reconstruction is not however suitable for all patients with irreparable cuff tears. If you already have established arthritis then this operation is unlikely to help. You must also have some residual rotator cuff tendons posteriorly for the reconstruction to work. Mr Granville-Chapman will explain to you whether this operation could help you.
Your joint and subacromial space are inspected arthroscopically (keyhole) and cleared of any inflamed tissue. Any old implants or suture material from previous rotator cuff surgeries are removed. If your long head of biceps tendon is still present, it is tenotomised.
The bone surfaces at the top edge of your glenoid socket and at the planned graft insertion site on your humerus tuberosity are cleared of debris and freshened to optimise healing.
A very strong porcine graft is then secured in a bridge fashion across the gap between your socket and your humerus. It is attached firmly to your bones using strong suture anchors. The graft is then sutured side-to-side to your residual posterior rotator cuff tendon and muscle.
An animation of this procedure is available if you copy this link into your browser: https://www.arthrex.com/resources/animation/kwHmylIu6kyO_gFOq5hQVg/superior-capsular-reconstruction
You will go home either on the same day or the day after your operation. Please take your prescribed painkillers regularly for the first few days and start them before your nerve block wears off.
You can take down any bulky padded dressings on day 2, but keep your wounds covered with the waterproof dressings for 12 days. Showering is fine after four days with dressings on.
You will need to wear your sling for the first six weeks and to limit the motion across your graft repair site. The physiotherapists will give you advice on what you should and should not do. After six weeks you will progress to more active motion in your shoulder and you will begin to strengthen it from three months.
Patients vary in their symptoms after surgery, but in general you can expect to return to:
Office work (in a sling) after two or three weeks for many, but you may still be too sore
Light physical work after 12 weeks
Heavy labour or overhead sport will take 26 weeks
Driving is allowed once you are confident and competent to control a car both for routine and emergency manoeuvres. This is unlikely before 8 weeks.
You will be seen at two weeks after your operation. Depending on your progress, your on-going follow up will vary. Most patients can be discharged between by six months after surgery.
Emerging data for this procedure is very encouraging, especially as this problem (a young patient with irreparable rotator cuff tear) was previously hard to treat.
Patients are reporting significant improvements in active function and pain of their shoulders. As this is a relatively new technique, longer-term data are awaited and many patients are now enrolled in longitudinal studies to assess this.
Arthroscopic shoulder surgery is generally very safe, but specific risks of superior capsular reconstruction include:
Stiffness (5%) which occasionally requires further surgery
Lack of benefit (approx. 10-15%) - remember, it can take 9 months to gain the full benefit from this operation
Infection (1%) – Arthroscopic surgery is low risk for infection. The graft material used in the SCR is sterile just like any other implant. The porcine dermal cells have been removed during processing of the graft to minimize the reaction of your body to a foreign material. The chance of acquiring any viral or animal infection is minute. As with any rotator cuff repair, you will be given antibiotics at the time of your operation