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Patients with massive irreparable rotator cuff tears are typically met with very limited options. When conservative measures such as injections and therapy have failed and patients continue to have pain, recent trends have been to surgically proceed with reverse shoulder replacement. This operation, initially intended for patients 70 and older, has been performed in younger and younger patients. As a shoulder specialist, however, I am reluctant to jump to this in a younger patient that is typically still working at a high level due to the restrictions this imposes on weight and manual labor. Replacement surgery also becomes a “scary” option even in physiologically younger patients that maintain a high level of activity. The bigger dilemma is that ten-year data on reverse shoulder arthroplasty would suggest that between 10-15% of patients will require revision surgery 10 years following the procedure. A person in their 50s that would have this surgery is almost guaranteed a revision surgery at some point in their lifetime.

Picture of Arthroscopic Superior Capsular Reconstruction

A newer procedure recently described by Dr. Mihata is called the superior capsular reconstruction. In the face of a large rotator cuff tear, the humeral head over time will gradually drift up and out of the socket. The rotator cuff helps depress the humeral head and without its downward force, the upward pull of the deltoid gradually leads to this change that can be seen on a standard x-ray. The goal of the capsular reconstruction, therefore, is to reconstruct the superior capsule with a piece of cadaver tissue (generally taken from the small of the back) which then serves as a checkrein and prevents superior migration of the head. It is sewn into the top of the socket and then into the insertion of the rotator cuff and again essentially serves as a blanket or roof to help recover the humeral head. Theoretically this helps maintain the natural mechanics of the shoulder and can restore function and reduce pain. In the largest series currently published on 22 patients, all parameters were statistically improved including motion, strength and pain. In addition, 8 patients that were manual laborers were able to return to their manual job following surgery.

I was the first shoulder surgeon in Indiana to perform this surgery and educate other surgeons in learning this technique. While early results are promising, further study will be necessary to determine the long-term viability of this technique. If you are younger and have been advised that a reverse shoulder replacement is your only option, I would be happy to see you in consultation to better determine if this procedure is right for you.

Other Shoulder Procedures

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