What's in My Bag with Alan M. Hirahara, MD, FRCS(C)
Joint Preservation with Superior Capsule Reconstruction (SCR)
Q. Is SCR a new technique? What does it do and how are the long-term results?
A. The SCR was pioneered by Dr. Teruhisa Mihata in 2007 for patients with irreparable rotator cuff tears. He recently published 24-51 month follow-up on 24 of his patients, showing outstanding outcomes in pain, ASES scores and acromial-humeral distance measurements. This technique recreates a superior capsule to keep the humeral head reduced in the glenoid by attaching tissue from the glenoid to the greater tuberosity.
Q. What are the potential risks of SCR or are patients better off with a reverse TSA?
A. The SCR does not burn any bridges and can be performed arthroscopically. The procedure carries minimal risk, as compared to a reverse total arthroplasty, which has increased risk of infection, failure, fracture, neurovascular complications and many more. Japanese surgeons have accepted the SCR technique as the reverse was just recently approved for use in Japan in July 2014.
Q. Can you comment on your own clinical experiences and patient results?
A. We have refined this challenging procedure to make it simpler for the surgeon and less painful for the patient. My patients have been uniformly excited about their outcomes. Having had multiple failed attempts at rotator cuff repairs, they have all commented at how much easier the rehabilitation has been and how much less pain they have had. My results are consistent with Dr. Mihata’s report.
Q. How do you perform the procedure?
A. I use a 3.5 mm ArthroFlex dermal allograft. We measure the defect and cut the graft to size. Beach chair positioning is preferred as this allows the arm to be placed neutrally for fixation so as not to over tighten the graft. The graft is placed arthroscopically with a PASTA Bridge fixation medial to the labrum on the glenoid and a SpeedBridge laterally on the greater tuberosity. We retain the labrum for stability. We attach the graft to the infraspinatus to prevent escape of the head. The anterior margin of the graft is attached to the remaining rotator interval tissue; however, if no tissue exists, then the graft should not be over constrained by attaching to the subscapularis.
Q. Your experiences would suggest this is a promising technique. What are your thoughts looking forward?
A. There are limited solutions between repair and arthroplasty for patients with irreparable massive rotator cuff tears without arthritis. I see this becoming the newest option in our bag to help the younger, nonarthritic active patients.