A meeting in Sydney
It was terrific to be part of the superior capsular reconstruction (SCR) interest group that met in Sydney, shortly before the coronavirus pandemic lockdown.
What superior capsular reconstruction is
The superior capsule is a layer of tissue across the top of the shoulder joint. In superior capsular reconstruction a graft is fixed from the rim of the socket to the top of the upper arm bone, re-creating a restraint that stops the ball riding upwards when the arm is lifted. It was developed for large rotator cuff tears in which the tendon has retracted and degenerated too far to be reattached to bone, a situation in which a conventional repair is not an option. Individual results vary.
Alan Hirahara presenting
Alan Hirahara, visiting from the United States, presented his experience with superior capsular reconstruction. Discussion with several of the other surgeons present covered their own experience with the technique.
An interest group is a small, informal gathering of surgeons who are all using the same technique, meeting to pool what they have found. It fills a gap that formal publication leaves: a paper reports a series after the event, whereas a group of this kind lets a surgeon raise a problem while it is still unresolved and hear how others have handled it. Where a technique is relatively new, that exchange is often where the practical detail is settled.
Reinforcing large repairs
One of the subjects discussed was the use of superior capsular reconstruction to reinforce large rotator cuff repairs, with the aim of reducing the chance of the repair retearing. Published series report retear rates after repair of large tears that are considerably higher than for small ones, which is the reason for interest in reinforcement. Individual results vary, and this remains an area in which practice is still developing.
The underlying difficulty is that a repaired tendon has to heal back to bone while the shoulder is being used, and a large tear is repaired under more tension and with less healthy tendon to work with. Adding a graft is one of several approaches being examined to take load off the repair while that healing happens.