Arthroscopic Transosseous Superior Capsular Reconstruction

• Published in: Arthroscopy techniques (Amsterdam) 2023-08, Vol.12 (8), p.e1259-e1263
• Main Authors: Hsieh, Chi-Kun, Chien, Chi-Sheng, Lin, Sheng-Hui
• Format: Article
• Language: English
• Subjects: Technical Note
• ISSN: 2212-6287; 2212-6287
• DOI: 10.1016/j.eats.2023.03.022

Superior capsular reconstruction is a common treatment option for irreparable rotator cuffs. Arthroscopic surgery procedures mostly use anchor-based methods. However, difficulty in preoperative graft measurement and intra-articular knot-tying present an obstacle for most sport surgeons. Complementing the known advantages of the transosseous technique in rotator cuff repair, a feasible, economical arthroscopic transosseous superior capsular reconstruction technique is described in this Technical Note. This procedure results not only in similar fixation strength and stability and greater bone stock but also in greater cost effectiveness due to using fewer anchors. This Technical Note describes the procedure in detail and compares it with conventional procedures. Video 1 Patients undergo surgery in the beach-chair position. A standard posterior portal is created for arthroscopic visualization. Intra-articular management, including debridement or labral reattachment, is performed via the anterior portal. Then, the scope is shifted to the subacromial space from the posterior portal, and bursectomy is undertaken via the anterior portal. The irreparable cuff tear edge is debrided to approach the medial aspect of the superior labrum. Two inlets are created: one anterior inlet near the biceps groove and one 2-cm inlet posterior to the anterior tunnel inlet. The ETHIBOND 5-0 suture needle tip is visible through the posterior portal and is grasped using a curved needle holder introduced via the lateral portal. The needle tip is introduced into the medial row inlet with a needle holder, and the lateral humeral cortex is pierced. The scope is shifted to the subdeltoid space for retrieval of the needle tip using the curved needle holder through the lateral portal. The ETHIBOND suture is left in the tunnel for shuttle purposes. Next, 3.7-mm all-suture anchors are fixed at the superior glenoid. Single-limb sutures are retrieved from 2 anchors outside via the lateral portal, and the proximal allograft edge is pierced. The graft is delivered along two sutures of glenoid-fixed anchors using a knot pusher. Glenoid graft fixation is achieved by tying knots at each all-suture anchor. After corner knots are tied, an extra knot is tied at the center of the proximal graft edge using each of the corner sutures. Suture tunnel entry points are located using the scope to determine the following piercing site on the graft. The graft undergoes intra-articular piercing, and tunnel suture