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Shoulder: Irreparable supraspinatus ruptures and superior capsular reconstruction

Introduction to the supraspinatus and its function

The supraspinatus muscle is an essential component of the rotator cuff. It provides stability in the shoulder and enables the arm to be raised. The muscle originates from the supraspinatus fossa of the scapula and attaches to the greater tuberosity of the humerus.

A tear of the supraspinatus leads to limited shoulder mobility, pain and muscle weakness. While minor tears can often be treated conservatively, severe or irreparable ruptures require surgical intervention.

Irreparable supraspinatus ruptures and superior capsule reconstruction

Understanding irreparable supraspinatus ruptures

A supraspinatus rupture is considered irreparable if:

  • The tear is too large and there is considerable tendon retraction.
  • Muscle atrophy and fat degeneration make recovery unlikely
  • Previous surgical interventions to repair the rotator cuff have failed.
  • The tendon cannot be mobilized to be reattached to its attachment.

In such cases, alternative treatment options are required to restore shoulder function and relieve pain.

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Treatment options for severe supraspinatus ruptures

Conservative therapy

For a few patients, non-surgical treatment may be considered, including:

  • Physiotherapy to strengthen the surrounding muscles and improve stability.
  • Corticosteroid injections to relieve pain and inflammation.
  • Adaptation of activities to avoid strenuous movements
  • Orthoses or slings to relieve the shoulder.

However, surgical interventions are necessary for most patients with significant functional limitations in order to restore mobility and reduce pain.

Superior capsular reconstruction (SCR) as a solution

How the SCR works

The superior capsular reconstruction replaces the defective supraspinatus tendon with a graft. This acts as a stabilizing bridge and prevents the humeral head from moving upwards.

Types of transplants for the SCR

Various biological and synthetic materials are available for superior capsular reconstruction:

  • Autografts - the patient's own tissue, e.g. fascia lata from the thigh or biceps tendon.
  • Allografts - donor tissue, often from dermal matrix grafts.
  • Synthetic grafts - Made from biocompatible materials, but less commonly used.

Autografts and allografts are the preferred materials as they integrate better into the tissue and offer high biomechanical stability.

Surgical procedure and techniques

The procedure is carried out in several stages:

  • Arthroscopic assessment - The surgeon evaluates the extent of the damage.
  • Graft preparation - The selected graft is cut to the correct size.
  • Fixation to the glenoid - The graft is fixed to the upper joint socket.
  • Anchoring to the humeral head - The graft is stably fixed with suture anchors.
  • Final check - The surgeon ensures that the tension and position are optimal.

Advantages of superior capsular reconstruction

  • Preservation of the natural joint - In contrast to a shoulder prosthesis, the patient's own joint is preserved.
  • Improves shoulder function - stabilizes the joint and prevents cranial migration of the humeral head.
  • Minimally invasive - shorter recovery time and less post-operative pain.
  • High success rate - Especially in patients with a functioning deltoid muscle and intact posterior rotator cuff.
Are you suffering from irreparable supraspinatus ruptures and superior capsule reconstruction and looking for a specialist?
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Who is a suitable candidate for the SCR?

The superior capsule reconstruction is particularly suitable for:

  • Active patients who want to avoid a shoulder prosthesis.
  • Patients with persistent pain and functional limitations despite conservative therapy.
  • People with an intact posterior rotator cuff and well-functioning deltoid muscle.
  • Patients with failed rotator cuff repair.

Recovery and rehabilitation process

Targeted rehabilitation is crucial to the success of treatment. The general healing process includes

  • First 6 weeks: Immobilization in a sling, passive movement exercises.
  • 6 to 12 weeks: Slow introduction of active movements.
  • 3 to 6 months: Strengthening exercises and functional training, complete recovery with optimum mobility and strength.

Success rates and case studies

Studies show that SCR provides significant pain relief and functional improvement in over 85% of cases. Success depends on factors such as age, muscle quality and postoperative rehabilitation.

Frequently asked questions

Complete healing takes about 6 months, with gradual improvement in mobility.

Most patients report significant pain relief and improved function.

Possible complications include graft failure, infections or stiffness, but these are rare.

Patients with severe osteoarthritis or poor deltoid function may require other procedures.

SCR preserves the natural joint and is therefore more suitable for active patients.

Contact for further information

If you suffer from shoulder pain or have limited mobility, contact me for a consultation.

The following languages are spoken in my ordination:

German, English, French, Russian, Slovak, Czech

My ordination in 1190 Vienna
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