Superior Capsular

Reconstruction (SCR)
By: Alex Garcia, SPTA
What is a Superior Capsular Reconstruction?

• A surgical procedure that is performed when an individual has a irreparable rotator

cuff tear of the shoulder and is not a candidate for RTC Surgery, A superior
capsular reconstruction may be recommended. Also if it is determined that physical
therapy will not resolve the tear . In this procedure the patient undergoes a
reconstruction of the superior capsule of the glenohumeral joint to be able to regain
the superior translation that is impaired due to the RTC tear by using either an
autograft ( self) such as the TFL autograft or dermal allograft ( donor). The graft is
then anchored between the upper end of the shoulder and the upper aspect of the
humeral head Which will hold the Humeral head into the socket of the shoulder.
 Shoulder Anatomy Overview.
RTC muscles that make up
the shoulder complex
• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis
 The purpose of this procedure is to restore shoulder
stability to allow for functional mobility. This procedure
can be performed either as an open or Arthroscopically
( less invasive)procedure, Procedure types
 Positions of procedure
Can be performed in a lateral decubitus position or beach
chair position.
 Indications for SCR
• Massive rotator cuff tears that are not able to be repaired.
• OA of the shoulder joint ( Chondromalacia) degeneration of the cartilage
that serves as a cushion within the shoulder joint.
• Superior GH migration to the acromion process ( crepitus)
• Shoulder dysfunction causing immobility which can lead to restricting of
activities of daily living.
 Advantages vs disadvantages.

Advantages Disadvantages/ risk factors

• Avoid progression of OA
• shoulder stability and mobility will be
restored
• Can assist by Decreasing pain
• improve shoulder flexibility
• Improved muscle strength.
• Infection
• Severe stiffness
• Excessive inflammation
• Possibility of re-tear of one
or all of the RTC muscles.
 Peer review article #1
Goals of this article: To describe the literature on the rehabilitation protocols after SCR of rotator cuff tears, with emphasis on the timing of the
introduction of motion in order to determine What is the best protocol approach to begin with after surgery.

Experiment: For this article we summarized the study characteristics, patient demographics, rehabilitation protocols after SCR such as
duration of immobilization, Initiation of passive range of motion, AAROM ,AROM , Strengthening and return to activities. In a subgroup
narrative analysis, rehabilitation protocols were stratified by graft type into autograft and other types of grafts.

Results: After SCR, an abduction immobilizer was recommended for a duration of 3 to 6 weeks after surgery. Of the 21 studies, 7 (33%)
started passive ROM during the first week, and 5 reported strict immobilization without motion for up to 6 weeks. All 8 studies that reported
return-to-sports timing recommended delaying return until at least 6 months postoperatively. Passive ROM was recommended earlier for
patients with non autograft versus autograft There was a high level of dissimilarity in the rehabilitation protocols after SCR.

Conclusion: Out of the 21 studies Majority (7) started passive range of motion during the first week while continuing with mobilization for at
least up to 6 weeks . 8 of those studies suggested to delay return to sport function at least until 6 months post op.
 Peer review article #2
Goals of the article: The aim of this study is to compare the early clinical outcomes of patients who have
undergone arthroscopic SCR with different types of grafts (allograft vs. autograft).

Experiment: All patients were monitored with a minimum follow-up of one year after the SCR.

Results: Three patients (7.5%) in the autograft group, and 14 (35%) in the allograft group had a
complication, respectively, required revision surgery. Linear regression ruled out any significant difference
between the 2 groups, with respect to clinical scores

Conclusion: In both groups, clinical scores improved after SCR in patients with irreparable rotator cuff tears.
Fewer complications and revisions were observed with the autograft (self) compared to the allograft
( donor). Indicating that using an autograft demonstrates a higher success rate after a superior capsular
reconstruction.
 SCR procedure demonstration

• https://youtu.be/Lf9HS0gfbBo
• In this video we will see the procedure of a superior capsular
reconstruction.
 Treatment post superior capsule
reconstruction
Immediately post surgery
• Abduction immobilizer is recommended up until 6 weeks post surgery
depending on patient’s progress. ( refer to protocol hand out)
 Protocol ( general overview)
phase 1:
( 0-2 weeks none, immobilized at all times at shoulder)
elbow/wrist ROM, grip strengthening and pendulums at home. ) ( 2-6 weeks) begin PROM, limit ER
to 45°.)

Phase 2 : (6-12 weeks) begin AAROM/ AROM , deltoid isometrics at 8 weeks, resistance exercises for
scapular muscles, biceps, triceps and RTC muscles. ROM restrictions. as follow 135° of abduction,
90° of abduction and external rotation, 45° of ABIR.

Phase 3 ( 12-16 weeks) gradual return to full AROM ( strengthening, progress activities in phase 2)
 HEP
• Acute phase 1 (0-2 weeks) grip strengthening with gripper 3 sets of 10 reps,
pendulums into flexion, extension 3 sets of 10 reps.

• Intermediate phase 2 : AAROM into flexion with cane 2 sets of 10 reps,

AAROM abd 2x 10 reps. Flexion, abd, ext isometrics at 8 weeks.
• Return to function phase 3: return to AROM strengthening, muscle endurance
activities., eccentric strengthening.( flexion , Abd with 5 lbs 2 sets of 10)
 Conclusion
• In conclusion based on these articles superior capsular
reconstruction‘s with autografts along with protocols that
follow immobilization into abduction slings demonstrate to
have a more successful and effective rate when recovering from
a superior capsule reconstruction procedure.
 References
• References Zhang, K., Xia, Q., Lai, S., Li, J., & Fu, W. (2022). A Scoping Review of
Postoperative Rehabilitation Protocols After Superior Capsular Reconstruction for
Irreparable Rotator Cuff Tears. Orthopaedic Journal of Sports Medicine, 10(9),
23259671221120052. https://doi.org/10.1177/23259671221120052

• References Lädermann, A., Denard, P. J., Barth, J., Bonnevialle, N., Lejeune, E., Bothorel,
H., & Nourrissat, G. (2021). Superior capsular reconstruction for irreparable rotator cuff
tears: Autografts versus allografts. Orthopaedics & Traumatology, Surgery & Research :
OTSR, 107(8S), 103059. https://doi.org/10.1016/j.otsr.2021.103059

• https://youtu.be/Lf9HS0gfbBo