Name: Superior Capsular Reconstruction (SCR) for Pseudoparalysis
Uploaded: 2017-01-09T00:00:00Z
Channel: Arthrex

Stephen S. Burkhart, MD, (San Antonio, TX) shares a case where he performed a Superior Capsular Reconstruction (SCR) using an ArthroFLEX®* SCR human dermal allograft in a patient who had a massive cuff tear with pseudoparalysis. The patient was an active 72-year-old rancher who was not a good candidate for an arthroplasty solution. Dr. Burkhart shows the patient at 1-year follow-up and highlights how the SCR was able to provide a biologic solution to reverse his pseudoparalysis.
*ArthroFLEX is a registered trademark of LifeNet Health.

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VPT1-00722-EN | A | Superior Capsular Reconstruction (SCR) for Pseudoparalysis

Stephen S. Burkhart

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Superior Capsular Reconstruction (SCR) for Pseudoparalysis

I'm Steve Burkhart from San Antonio, Texas, and I want to show you a very interesting case today of a man who had a superior capsular reconstruction for pseudo paralysis. This was a 72 year old rancher. And a lot of you might say, well, he's too old for an SCR. He should just be getting reverse total shoulder. But you have to understand, this is a very active man who has to do heavy work on his ranch. He really would not be appropriate for a reverse total shoulder replacement. He's had two failed rotator cuff repairs already. He has constant pain and he has pseudo paralysis. His active elevation is only 30 degrees. He has passive elevation of 150 degrees. He has a positive Hornblower test. He has very weak, resisted external rotation strength. You see his exam? He can just barely get up to about 30 degrees. Actively, passively. You can raise them, but he can't hold it beyond 30 degrees. On his MRI scan, you see here on the coronal view that he's got a massive rotator cuff tear with retraction up to the glenoid rim. He has a tear of the upper subscapularis as well, and he's got probably greater than 50% fatty infiltration of the supra and the infraspinatus muscles. So my plan was to do a partial cuff repair as much as possible, and then to augment that with a superior capsular reconstruction. This is his surgery. You see, he had such a degenerative labrum. We're looking down from a lateral portal at the glenoid. And the superior glenoid does not have a labrum. We place two anchors, one anterior, one posterior. Looking through this lateral viewing portal, we measure between all the anchors, both the humeral and the glenoid anchors, so that we know how to size our graft. And now we show the steps of putting our graft in place. We use a modified double pulley medially for fixation to the glenoid. Laterally we use a SpeedBridge type of technique, fixing our fiber tapes out laterally. And then we also do side to side sutures from the graft to the posterior soft tissue that is the infraspinatus. And if there is any soft tissue to tie into anteriorly, such as the comma tissue will do that. Also, if we've done a biceps. Tenodesis up at the top of the of the bicipital groove. We'll use those sutures to restrain it. Anterolaterally. The patient at one year post op rated his shoulder as feeling 90% of normal. He had regained active elevation of 160 degrees, so total reversal of his pseudo paralysis. He had excellent external rotation strength. So now you see his exam here at one year post op. You see his full active elevation. He is able to do all the work on his ranch that he used to do. He's very happy. And in fact, I thought it would be a great idea to just to ask him what sort of difference this surgery had made in his life. And this is his answer. It's changed my whole life. I mean, I've got my life back because you and your staff. Thank you. Thank you very much. So, as you can see, the superior capsular reconstruction can make a huge difference in active people who need to get back as much function as possible without an arthroplasty solution. This is a biologic solution that I think deserves a lot of attention. For those of you that treat patients like this. Thank you very much.

Superior Capsular Reconstruction (SCR) for Pseudoparalysis

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