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Superior capsular reconstruction provides stable function, achieves joint preservation
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KOLOA, Hawaii – Superior capsular reconstruction offers an effective biologic alternative to reverse shoulder arthroplasty, according to a presenter here at Orthopedics Today Hawaii 2018.
“When you think about superior capsular reconstruction (SCR), I think it is good to think of in terms of joint preservation,” Stephen S. Burkhart, MD, said.
Good clinical success with SCR as a joint preservation option has been achieved by using fascia lata as an autograft, he said. However, dermal allograft has recently been proposed as a graft source as well, he said.
Burkhart said patients who should get SCR include active patients with an irreparable tear of the supraspinatus/infraspinatus; minimal or no glenohumeral arthritis; functional deltoid/trapezius; intact or repairable subscapularis tendon; and active patients with a failed rotator cuff repair and deficient capsule.
Burkhart said that as of December 2017, his personal series of SCRs included 115 patients with more than 3 years, which included two failures that required revision surgery. His results at 1-year follow-up on 51 patients who had MRIs indicate forward flexion increased from 137° preoperatively to 165° postoperatively. Additionally, the ASES scores averaged 88 postoperatively from a score of 49.2 preoperatively. The VAS scores were less than 1 postoperatively, and the SANE score went up from 38.2% preoperatively to 85.7% postoperatively.
“Keep the SCR in mind as it provides a stable fulcrum, optimizes force couples and achieves joint preservation," he said. – by Kristine Houck, MA, ELS
Reference:
Burkhart SS. Superior capsular reconstruction updates for 2018. Presented at: Orthopedics Today Hawaii 2018; Jan. 7-11, 2018; Koloa, Hawaii.
Disclosure: Burkhart reports he is a consultant for and receives inventor royalties from Arthrex.