In Osaka
Several days in Osaka with Dr Teru Mihata at Osaka Medical College, learning the techniques he developed.
What a visitation is
A visitation, sometimes called an observership, is a short period spent in another surgeon's unit watching them operate and discussing their cases. It differs from a fellowship, which runs for a year or more and involves taking part in the clinical work; a visitation is measured in days and is usually directed at one technique. Travelling to the surgeon who first described an operation is a direct way to learn it, because the sequence and the small decisions that make it work are difficult to convey in a paper or a video.
Superior capsular reconstruction
Superior capsular reconstruction (SCR) is an arthroscopic procedure for irreparable rotator cuff tears, which Dr Mihata first described. It uses fascia lata, a sheet of strong connective tissue taken from the thigh, as a graft to reconstruct the capsule across the top of the shoulder joint.
Where it is appropriate, it may avoid the need for a joint replacement, which is of particular interest in younger patients who would be likely to outlive an implant. Whether it is suitable depends on the individual shoulder.
Why the top of the joint matters
The rotator cuff holds the ball of the shoulder centred against its socket while the deltoid lifts the arm. When the cuff tendons at the top of the joint are gone, nothing resists the ball riding upwards, and the arm becomes difficult to raise even though the deltoid still works. A graft fixed from the upper rim of the socket to the top of the arm bone restores a restraint in that position. It does not replace the pull of a tendon, since it has no muscle attached to it, but it can hold the joint down so that the deltoid acts more effectively. Individual results vary.
Reinforcing large repairs
A related technique uses the same principle to reinforce large rotator cuff repairs rather than to replace absent tendon. Published series from Dr Mihata's group report low rates of retear with these combined repairs. Individual results vary, and the figures are in the published work rather than reproduced here.
Two assisting surgeons during the visit came from the Japanese Red Cross Musashino Hospital and Charoenkrung Pracharak Hospital.