Name: Superior Capsular Reconstruction With ArthroFLEX® Graft: Does the Graft Heal?
Uploaded: 2016-12-15T00:00:00Z
Channel: Arthrex

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VPT1-00723-EN | C | Superior Capsular Reconstruction With ArthroFLEX® Graft: Does the Graft Heal?

Stephen S. Burkhart

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Superior Capsular Reconstruction With ArthroFLEX® Graft: Does the Graft Heal?

I'm Steve Burkhart from San Antonio, Texas. One of the things that I get asked a lot when I talk about supercapacitor reconstructions is, does the graft really heal? And I want to show you a case today where the patient had a second look because of a re-injury. And we showed unequivocally that the graft had healed. This was a 56 year old man, very athletic, liked to lift weights. He'd had a prior failed rotator cuff repair. Two months after I did a capsular reconstruction on him, he was lifting weights in the gym against medical advice. He ruptured the long head of the biceps on his operative side. And he wanted that fixed. So this gave us an opportunity to examine him further. His preoperative MRI scan on the left shows that he had a massive cuff tear that was retracted to the level of the glenoid at two months post op, we got this new MRI that showed he had excellent coverage over the top of the humeral head, and the graph looks quite good. The findings of the first arthroscopy are shown here, and you see that a tear of the upper subscapularis, he had had a tear of this supra and infraspinatus area has a very hostile environment for healing, as you can see, fibrous tissue all over the top of his greater tuberosity. So we did a partial repair, but then the supra and infraspinatus were largely irreparable. So I did a superior capsular reconstruction. You see the graft here. This is our lateral fixation with our SpeedBridge, then our posterior suture line. So our second look was actually done at three months post-op. Although he had injured himself at two months post-op, the graft appeared to be tensioned physiologically. His he had vascular ingrowth on the periphery. And you can see here intra-articular looking from a posterior viewing portal, you see the shaggy undersurface of the graft. You see the medial fixation of the graft here. And over laterally onto the humeral side. We go up into the subacromial space. Now and you can see this. There are some vascular markings at the margins of the graph. You see the SpeedBridge fixation on the left, which is lateral, and you see our anterior suture line here. And now we'll scan across it and you can see back over all the way. Then laterally, one of the things I wanted to look at was how much a restraint to superior migration this graft was. And I wanted to probe the graft and push the humeral head proximally. Some of you have probably seen this demonstration by Chris Adams where on a cadaver he did a superior capsular reconstruction. And he shows here how the graft is a restraint to proximal migration of the humerus. Then he cuts the graft and totally destabilizes the shoulder. He is able to push the humeral head right up under the acromion and to sublux it inferiorly, much more than it had been before. So this provided very much of a destabilizing effect by cutting this graft. So I wanted to look at our graft in this patient with that demonstration in mind. And so I'm probing the graph from a lateral viewing portal. You see there's our posterior suture line. I'm pushing the humeral head up. And it just kind of bounces like a reverse trampoline. Now look inside the joint from a posterior viewing portal, and the same thing in the humeral head is just bouncing off of that reverse trampoline of the graft. So I think one of the things that we can learn from cases like this is that a stable fulcrum is so important. And if you look at part of the principle of why a reverse total shoulder works is it provides a stable fulcrum and keeps the humeral head from migrating proximally. In the case of the superior capsular reconstruction, you might even think of it like a biologic reverse, because it is providing a stable fulcrum, preventing proximal migration and thereby optimizing the force couples. So keep this operation in mind for these young, active people. I think it's going to be very gratifying to you to see how well they can do. Thank you.

Superior Capsular Reconstruction With ArthroFLEX® Graft: Does the Graft Heal?

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