Capsule Reconstruction Restores Large Rotator Cuff Tears

An innovative arthroscopic graft procedure for treating massive rotator cuff tears may help patients return to sports and work quicker.

Researchers at Osaka Medical College (Japan) followed 100 patients (average age 66 years) who underwent arthroscopic superior capsule reconstruction (ASCR) for irreparable rotator cuff tears between 2007 and 2014; all patients had failed previous surgical treatment. Physical exams, X-rays, and magnetic resonance imaging (MRI) were performed prior to surgery and also again at 3, 6, 12 months, and yearly thereafter. Return to sport and work rates were also analyzed in 34 patients who were employed and 26 patients who were recreational athletes prior to injury.

The results showed an average postoperative outcome score of 92%, with significantly improved strength and shoulder function. Thirty-two of 34 patients returned fully to their previous work, with the other two patients returning with reduced hours and workloads. All 26 patients who played sports prior to injury also returned fully to their activities. The study was presented at the American Orthopedic Society for Sports Medicine (AOSSM) specialty day, held during March 2016 in Orlando (FL, USA).

“Arthroscopic superior capsule reconstruction restored shoulder function at a greater rate than previous forms of treatment, and helped return our patients to recreational sport and work faster,” said lead author Teruhisa Mihata, MD, PhD. “Our positive results suggest that this procedure is a viable option for irreparable, large rotator cuff tears. We hope to perform additional research to further solidify our results.”

ASCR involves using a fascia lata—the deep fascia of the thigh—tissue graft attached medially to the superior tubercle of the glenoid and laterally to the greater tuberosity, with concomitant arthroscopic repair of the torn subscapularis tendon. Side-to-side sutures are then added between the graft and the infraspinatus tendon and between the graft and the subscapularis tendon to improve force coupling in the shoulder joint.

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Osaka Medical College