Shoulder Superior Capsule Reconstruction Surgery

Superior capsule reconstruction (SCR) is a surgical procedure used to treat rotator cuff tears in the shoulder. It is especially applied in large and irreparable rotator cuff tears. The goal of SCR is to increase the stability of the shoulder, reduce pain, and improve shoulder function.

The rotator cuff consists of the combination of four muscles in the shoulder and provides shoulder movements. Tears in these muscles can cause pain, limitation of movement and loss of function in the shoulder.

Some rotator cuff tears may not be repairable with conventional methods due to their size or location. For such tears, SCR may be a suitable alternative for the patient.

During the SCR procedure, the surgeon usually takes a tissue graft (sometimes from the patient’s own body, sometimes from the donor) and places this graft over the tear. This helps rebuild the superior capsule. The graft is attached to the healthy tissue and bones around the tear, making the shoulder joint more stable.

This operation can help restore the stability and mobility of the shoulder. It may also delay or eliminate the need for a shoulder replacement. However, as with any surgical procedure, SCR has risks. Therefore, patients considering this type of surgery are recommended to speak in detail with a shoulder surgeon to understand the benefits and risks of the procedure.

Who is the Ideal Candidate for Superior Capsule Reconstruction Surgery?

Superior capsule reconstruction (SCR) surgery is revolutionary in the treatment of rotator cuff tears. However, in order for this surgery to yield successful results, it is important to select patients who meet certain criteria.

Who is it suitable for?

1. Large and Irreparable Rotator Cuff Tears: SCR is particularly suitable for large-scale tears. However, it is preferred in cases where tendons are severely retracted and therefore difficult to repair with classical methods.
2. Long-Term Neglected Tears: Tears that are not treated over time can cause permanent changes in the tendons. SCR becomes an ideal option in the treatment of such tears.

Who is it not suitable for?

1. Advanced Joint Wear: SCR method should not be preferred when serious wear is observed in the shoulder joint. In this case, different treatment methods should be used to protect the health of the intra-articular structures and prevent loss of function.
2. Joint Deformities: In cases where the natural anatomy of the shoulder joint is disrupted, alternative methods such as reverse shoulder prosthesis can be considered instead of SCR.

In conclusion, Superior capsule reconstruction surgery offers an effective treatment option for patients who meet certain criteria. However, it is essential to decide on the most appropriate treatment method by evaluating each patient’s individual situation.

How is Shoulder Superior Capsule Reconstruction Surgery Performed?

Superior capsule reconstruction (SCR) surgery is a highly technical procedure used especially in the treatment of irreparable rotator cuff tears. In general, this process consists of two basic steps.

1. Texture Gain:
   • In the first step, the patient takes a comfortable position under general anesthesia.
   • The patient is prepared with a skin incision approximately 15cm from the thigh.
   • Through this incision in the thigh, the outer muscle membrane (fascia) is removed. Removing this membrane has no negative effect on the function of the muscle. Over time, the area where this membrane was removed is refilled by the body’s own natural processes.
2. Intervention in Shoulder Joint:
   • At this stage, an arthroscopic (closed) approach is preferred.
   • Approximately 1cm skin incisions are made around the shoulder and a camera and surgical instruments are inserted.
   • Specially designed screws are placed in predetermined areas in the shoulder joint and head bone.
   • Special durable surgical threads attached to these screws are passed through the previously removed muscle membrane.
   • Then, the membrane is transferred into the shoulder using the “Elevator Technique” and fixed to the head bone with threads.
   • This muscle membrane mimics the function of the rotator cuff. This helps keep the shoulder head in the correct position during joint movements. In this way, abnormal joint movements and bone friction are prevented.

SCR can greatly reduce patients’ pain and increase shoulder movement. This helps improve quality of life and allows patients to continue their daily activities comfortably.

Healing Process of Shoulder After Superior Capsule Reconstruction Surgery

After superior capsule reconstruction, the patient usually stays in the hospital overnight and is monitored. If the surgery is successful and there are no signs of complications, patients can usually return home within the first 24 hours following surgery.

First Weeks After Surgery:

• After surgery, patients’ arms are immobilized with a supported shoulder strap, especially for the first 6 weeks. This helps protect the surgical site and optimize the healing process.
• Stitches in the surgery area are usually removed after two weeks. During this period, the patient should keep the surgical area dry and clean. After two weeks, the patient is allowed to gently wash the wound area.

Medium Recovery Period:

• Starting from four weeks, the patient can start passive movements using the other arm. This helps gradually restore shoulder movement.
• At the end of the sixth week, patients are allowed to move their shoulders on their own. At this stage, a special physical therapy and rehabilitation program is recommended.

Advanced Recovery Period:

• Throughout the rehabilitation process, the patient’s shoulder movement and strength are gradually increased.
• At the end of the third month, patients can return to their normal daily activities and light sports.
• However, it is recommended to complete the sixth month before starting more intense and challenging physical activities.

The success of superior capsule reconstruction surgery depends on appropriate surgical technique, the patient’s individual recovery capacity, and compliance with the physical therapy program. It is extremely important for patients to stay in close communication with their surgeons and physical therapists and follow the recommendations during the recovery process.

Possible Complications of Superior Capsule Reconstruction Surgery

Although superior capsule reconstruction surgery is an advanced surgical method that aims to restore shoulder functions, it has some risks, just like other surgical interventions. Although the rate of these risks is generally low, the patient and surgeon should be aware.

1. General Complications: General surgical complications such as infection, bleeding, and nerve damage may occur after such surgeries. However, these risks are very rare in surgeries performed by an experienced surgeon and under appropriate sterile conditions.
2. Graft-Related Complications: During the surgery, the muscle membrane taken from the leg area is transferred to the shoulder. There is a risk of tearing or damaging the muscle membrane during or after this transfer process. However, thanks to modern surgical techniques, this risk has been reduced to a minimum.
3. Fluid Accumulation in the Leg: From time to time, fluid accumulation or edema may develop in the area where the muscle membrane was removed. This condition is usually painless and may regress on its own over time. However, if necessary, this fluid can be removed with simple medical interventions.
4. Joint Stiffness: After surgery, movement limitation or joint stiffness may develop in the shoulder. This situation can often be resolved with physical therapy and rehabilitation programs.

Every surgical procedure carries its own risks, and most of these risks are minimized by the surgeon’s experience, the techniques he uses and post-operative care. Patients’ strict compliance with doctor’s recommendations before and after surgery will further reduce the risk of possible complications.