Irreparable rotator cuff tears can make conservative treatment options difficult or ineffective. A doctor may recommend superior capsular reconstruction surgery in cases of severe tears.

The rotator cuff keeps the arm attached to the ball and socket joint of the shoulder. It consists of four muscles that converge into tendons around the head of the humerus bone. It helps to lift and rotate the arm.

Injury to the rotator cuff is a common cause of shoulder pain and disability. Superior capsular reconstruction surgery may help in cases where conservative treatment options are ineffective.

This article reviews superior capsular reconstruction, when someone might need it, what the procedure involves, and more.

A person is getting physio on their shoulder.Share on Pinterest
Westend61/Getty Images

Superior capsular reconstruction is a surgical procedure that treats irreparable rotator cuff tears.

The procedure involves using tissue from the person’s body to reconnect the torn rotator cuff. The procedure can vary based on several factors, including the type of graft used, whether it is open or arthroscopic surgery, and where a doctor inserts anchors into the shoulder.

Doctors may recommend superior capsular reconstruction surgery in people who do not have:

  • severe bone deformity
  • infection
  • severe movement of the humerus bone head outward or upward from the socket
  • nerve or deltoid dysfunction

The procedure may not be suitable for some older individuals.

The doctor treating a person with a rotator cuff tear will be able to discuss the suitability of the surgery and any other treatment options they recommend.

Learn more about torn rotator cuffs.

Experts recommend superior capsular reconstruction surgery for people with an irreparable rotator cuff tear with a fully functioning deltoid and intact subscapularis.

The deltoids are muscles in the shoulder that help to move the arms in different directions at the shoulder. The subscapularis is one of four muscles in the rotator cuff apparatus that is primarily responsible for internal rotation.

Superior capsular reconstruction surgery may be open surgery or arthroscopic surgery.

Open surgery involves making a larger incision and typically involves a longer recovery period.

Arthroscopic surgery is a type of keyhole surgery. It is a minimally invasive technique that involves making several small incisions. This type of surgery may have a shorter recovery time than open surgery.

During the procedure, the surgeon will place anchors into the bones of the shoulder. They use cadaver or autologous tendon tissue to bridge the injured rotator cuff to its original bony attachments.

The surgeon will then use sutures or stitches to pull the graft into the proper position. The sutures and graft attach to anchors in the shoulder bones and the end of the humerus to fix the torn rotator cuff.

Learn more about rotator cuff surgery.

A person should discuss preparation with the surgical team or facility where the team will perform the procedure. They can answer specific questions about when the procedure will occur, what medications a person may need to stop beforehand, and when to stop eating or drinking.

Eating or drinking immediately before surgery is typically not advisable. Food in the stomach increases the risk of vomiting before, during, or after anesthesia. Most facilities recommend stopping eating the night before for an early morning procedure or at least 6 hours before an evening surgery.

The Centers for Disease Control and Prevention (CDC) recommend that people take steps to help prevent surgical site infections. This includes:

  • quitting smoking if the person currently smokes
  • discussing any preexisting conditions with the surgical team
  • avoiding shaving near the shoulder
  • using soap the surgical team recommends to clean the area

Recovery times can vary. A person should follow all recommendations from the surgical team regarding how long to rest from activities, when to start rehabilitation, and any other instructions.

Generally, a person can expect to wear a sling or other supportive device for about 4–6 weeks after the surgery.

At about 8–12 weeks from the surgery, doctors often recommend physical therapy to help restore movement and range of motion to the shoulder.

Information on success rates is relatively limited due to few long-term studies. However, short-term success rates show it is generally effective in returning range of motion and reducing pain.

To determine improvement, some studies used the American Shoulder and Elbow Surgeon (ASES) scores to assess people several months after the surgery. Studies found that people showed continued improvement during this period.

Like all surgeries, superior capsular reconstruction surgery has some risks, such as:

  • reaction to anesthesia
  • infection at the surgical site
  • reinjury to the shoulder

Certain factors can increase a person’s risk of reaction to anesthesia. They include:

  • older age (ages 65 years and older)
  • living with underlying health conditions
  • obesity
  • sleep apnea
  • smoking

A person should discuss their risk of reactions to anesthesia with the surgical team before the surgery date. This may help reduce the risk of complications.

A person can also take steps to help prevent infections at the surgical incision sites. These can include:

  • following all instructions from a doctor
  • keeping the area clean and dry
  • regularly changing dressings
  • contacting a doctor if an infection may be present

Superior capsular reconstruction surgery uses a tissue graft to correct the torn rotator cuff.

A reverse shoulder replacement involves switching the ball and socket locations in the shoulder joint to provide improved, long-term stability in the shoulder. During the procedure, the surgeon will create a new socket at the top of the humerus and attach a prosthetic ball to the shoulder blade.

A doctor may recommend reverse shoulder replacement for several different conditions affecting the shoulder. They may include:

  • rotator cuff arthropathy
  • chronic irreducible shoulder dislocation
  • pseudo shoulder paralysis due to an irreparable massive rotator cuff tear
  • revision surgery for failed proximal humerus hemiarthroplasty

Healthcare professionals carry out superior capsular reconstruction surgery to fix a severely torn rotator cuff in the shoulder.

The procedure may be open surgery or arthroscopic surgery. In both cases, a person will need several weeks to recover and physical therapy to help regain strength and mobility.