What is a severe or irreparable rotator cuff tear?

The shoulder joint has the largest range of motion of any joint in the body. This is partially thanks to the group of four muscles and tendons that surround the joint known as the rotator cuff. The rotator cuff provides support and stability to the joint while helping to initiate shoulder movement, further allowing it to maintain its large range of motion. However, due to the significant amount of repetitive motion that occurs in this joint, rotator cuff tears or injuries can occur. A rotator cuff tear occurs when one or more of the rotator cuff components is torn from the humerus bone, thereby preventing its normal function. Large tears, especially those that have been present for many years, may not be amenable to repair. Dr. Joseph Lamplot, orthopedic shoulder surgeon, treats patients in Arlington Heights, Kildeer, Lake Zurich, Barrington, and the surrounding Northwest Suburbs of Chicago, IL, who have failed or who have irreparable rotator cuff tears and require surgical options that may include a superior capsular reconstruction, balloon spacer or tendon graft.

What is superior capsular reconstruction?

Superior capsular reconstruction is a procedure that offers a solution to some irreparable, or severe rotator cuff tears. This type of surgery allows a rotator cuff tear to be treated using a skin graft from a cadaver to fix the injured rotator cuff. Superior capsular reconstruction is performed arthroscopically. During this type of procedure, Dr. Lamplot will use a small camera (arthroscope) and other small specialized surgical tools placed within the shoulder. He will use a skin graft from a cadaver and attach it between the uppermost section of the arm bone (humerus) and the upper section of the shoulder. This recreates the capsule that is formed by the rotator cuff around the shoulder, which functions as a solution for irreparable rotator cuff tears or injuries. Superior capsular reconstruction allows for the existing, uninjured components of the rotator cuff to return to normal function, and to restore the range of motion these muscles allow in the shoulder.

What is a balloon spacer?

A balloon spacer is a device that can be used to treat irreparable rotator cuff tears.  This device dissolves over time (biodegradable) and is inserted into the shoulder through small incisions. The balloon is placed directly over the head of the humerus and is filled, or inflated, using sterile saline water. The balloon is positioned directly over the head of the humerus bone to keep the ball of the shoulder centered on the socket throughout the shoulder range of motion.

Dr. Lamplot has had great success in using the balloon spacer and prefers this repair technique to superior capsular reconstruction, with the majority of his qualifying patients. Based on the patient’s health, goals after surgery, and other considerations, he may use this technique to restore range of motion and strength to the shoulder. You may learn more about the balloon spacer HERE.

What is a tendon transfer?

A tendon transfer is when a muscle and its tendon are moved from one bone to another in order to make up for an injured or non-functional tendon and muscle. In the case of a rotator cuff tear, the lower trapezius tendon from the back of the shoulder blade can be transferred to the humerus bone in place of the torn rotator cuff. This allows the patient to elevate the arm above their shoulder and to reach out to the side. This procedure is done using both minimally invasive (arthroscopic) and open incisions along with an Achilles tendon graft from a cadaver (allograft).

Why would I need superior capsular reconstruction, balloon spacer, or tendon transfer?

There are a variety of reasons why a patient may need to undergo a superior capsular reconstruction, balloon spacer, or tendon transfer, such as:

  • Incorrect initial treatment of a rotator cuff tear: Occasionally, rotator cuff tears may be improperly diagnosed or fail to improve with nonsurgical treatment, warranting surgical intervention such as one of these surgical treatment options.
  • Inadequate strength from an initial attempt to repair the rotator cuff tear.
  • Failure of a rotator cuff tear to heal: A rotator cuff tear may not be able to heal on its own depending on the patient’s age, the age of the injury, and the size of the tear.

How do I know which one I need?

The decision to perform a rotator cuff repair, superior capsular reconstruction, balloon spacer, or tendon transfer depends on the extent of the injury, the patient’s age and activity level, and the patient’s goals. Dr. Lamplot will discuss all options with you, taking each of these factors into consideration.

How long does it take to recover from superior capsular reconstruction, balloon spacer, or tendon transfer surgery?

Immediately following a superior capsular reconstruction, balloon spacer, or tendon transfer surgery the patient will be required to wear a shoulder sling to prevent motion of the shoulder. This is critical to allow the site of the operation to heal properly. It is necessary to wear the shoulder sling for approximately 6 weeks after surgery, as well as follow detailed instructions Dr. Lamplot provides. High rates of success are seen after this procedure if all post-operative instructions are closely followed. After approximately 6 weeks, the patient will begin to attend physical therapy that is tailored to their specific needs. This will allow for strength and range of motion to be developed in the previously injured shoulder. Return to full activity can be expected after approximately 6 months.