Superior Capsular Reconstruction featuring Doctor Derek Shia
This is a video demonstration of a patient undergoing a superior capsular reconstruction. The patient is a 57 year old male with a large retracted rotator cuff tear involving the Supra and infraspinatus. Preoperative imaging demonstrated a large retracted rotator cuff tear seen here at the level of the glenoid. Sagittal cuts also demonstrate fatty infiltration of both the Supra and infraspinatus. Diagnostic arthroscopy demonstrates a large rotator cuff tear. Once again releases were performed but it was not mobile. The greater tuberosity was then prepared with use of a shaver followed by a burr to cordicating the bone. This is then repeated on the glenoid side and removing soft tissue from the superior aspect of the glenoid. Anchors are then placed at the anterior and posterior aspect of the glenoid. This is a knotless, corkscrew anchor being inserted. This is then repeated posteriorly. The greater tuberosity is then prepared and all is then utilized at the anterior aspect of the greater tuberosity adjacent to the articular margin. A swivel lock anchor with a fiber tape is then inserted this is then placed flush with the bone this is then repeated posteriorily once again an awl is utilized to make a hole at this point once again a super block anchor with a fiber tape is that inserted posteriorily. At this point, the distances between all four anchors are then measured. This is measuring between the two creator tuberosity anchors. This is measuring between the greater tuberosity anchor and the posterior glenoid anchor. This is repeated anteriorly between the greater tuberosity anchor and the glenoid anchor. And then between the anterior and posterior glenoid anchor. These measurements are utilized to trim the dermal allograft which is now outside the cannula. At this point the lateral fiber tapes are then retrieved through the lateral cannula. And pass through the dermal allograft. The glenoid anchors are then retrieved and once again also passed through the dermal allograft which is also done outside the cannula. Once this is performed the dermal allograph can then be shuttled interarticularily under direct visualization. A knot pusher can then be utilized to tighten down the glenoid anchors affixing the dermal allograft tightly to the glenoid side. These sutures can then be cut. At this point attention is then paid laterally. One of each of the fiber tapes is then retrieved laterally from the both the anterior and posterior swivel locks. And all is also utilized laterally to create a channel for the swivel lock laterally. At this point the swivel lock anchor is then inserted. It’s then tensioned bringing the lateral aspect of the dermal allograft under good tension. At this point the swivel lock is inserted and placed flush with the bone laterally. At this point a suture passer is then utilized anteriorly. This is place to the anterior aspect of the internal allograft as well as through the comma tissue anteriorly. These are then sequentially tied – tied down the anterior aspect of the dermal allograft. At this point it’s then repeated posteriorily once again an awl is utilized to perform a channel. Once again the swivel lock is then loaded with an anterior and posterior fiber tape. The swivel lock is then placed into the channel. Once again the fiber tapes are
then sequentially tightened. And the swivel lock isn’t advanced. At this point a suture passer is then utilized along the posterior aspect of the dermal allograft. Once again this is then tied to the anterior aspect of the infraspinatus. This is then sequentially tied down closing down the posterior aspect between the rotator cuff and dermal allograft. After completion of the see posteriorily that the interval is closed between the infraspinatus and dermal allograph medially the glenoid is well fixed. Laterally a speed bridge construct holds the lateral aspect of the dermal allograft in excellent position.