Peter J. Millett, MD, MSc

The sternoclavicular joint has high native stability, with static stabilization provided by the joint capsule, costoclavicular and interclavicular ligaments.

Superior capsule reconstruction is a new treatment option for massive, irreparable posterosuperior rotator cuff tears (Figure 1). The treatment goals for massive tears are to reduce pain, restore shoulder function and delay the development of cuff tear arthropathy. Superior capsule reconstruction is an exciting and promising new procedure that can achieve these goals. Moreover, superior capsule reconstruction can be performed arthroscopically, which minimizes the complication risk. Superior capsule reconstruction uses a bridging graft that is attached at the superior glenoid and at the greater tuberosity to re-stabilize and re-center the humeral head. Teruhisa Mihata, MD, who is credited with inventing the procedure, recently reported on 100 patients who underwent superior capsule reconstruction with fascia lata autografts at a minimum of 2-years follow-­up. In that series, the American Shoulder and Elbow Surgeons score improved significantly from 36 preoperatively to 92 postoperatively and MRI follow-up showed 95% of patients had intact capsule reconstructions.

The superior capsule reconstruction is a novel treatment option for massive, irreparable posterosuperior rotator cuff tears. Treatment goals of such tears are to reduce pain, restore shoulder function and delay the development of advanced cuff tear arthropathy. Current non-prosthetic treatment options include debridement and partial rotator cuff repair, bridging rotator cuff reconstruction with a graft and latissimus dorsi transfer, although each has different factors which limit their clinical applicattion.

Rotator cuff tears represent a significant source of shoulder disability and socioeconomic burden. Outcomes after rotator cuff repair have improved significantly in recent years. Understanding and recognizing common tear patterns is helpful to achieve a low-tension repair and to improve outcomes.