Arthroscopic Superior Capsule Reconstruction

In cases of massive irreparable supraspinatus tendon or combined supraspinatus / infraspinatus tendon tears, reverse total shoulder replacement can offer good results. However, in young and active patients with these types of irreparable posterosuperior rotator cuff tears limited prosthetic implant longevity and activity restrictions for high-impact activities make reverse total shoulder arthroplasty a less desirable option. Arthroscopic superior capsule reconstruction (ASCR) is an alternative technique for this pathology with advantages of minimal invasiveness, better approximation of the native anatomy, and the potential for easier future surgical revisions. The implantation of a graft replaces the torn superior rotator cuff tendon’s role as the superior capsule, thus preventing the humeral head from migrating superiorly by acting as a static restraint. This surgery alters shoulder sbiomechanics as the graft acts as a “checkrein,” re-centering the humeral head during abduction and forward flexion, preventing superior escape, and leading to imporved function and pain relief.