This is a keyhole operation performed under general anaesthesia and regional nerve block.
This relatively new technique was pioneered by a Japanese surgeon, Dr Mihata. It is designed for the younger patient (under 65 years) who has an irreparable rotator cuff tear and a significantly de-functioned shoulder in spite a good physiotherapy programme.
The aim of the capsular reconstruction is to rebalance your ball and socket joint of the shoulder, which has become compromised by the large rotator cuff tear. This enables you to use your deltoid muscle to move your arm more easily. It also potentially prolongs the life of your shoulder cartilage, as it helps to keep your humeral head centred in the socket during motion.
Superior capsular reconstruction is not however suitable for all patients with irreparable cuff tears. If you already have established arthritis then this operation is unlikely to help. You must also have some residual rotator cuff tendons posteriorly for the reconstruction to work. Mr Granville-Chapman will explain to you whether this operation could help you.
Your joint and subacromial space are inspected arthroscopically (keyhole) and cleared of any inflamed tissue. Any old implants or suture material from previous rotator cuff surgeries are removed. If your long head of biceps tendon is still present, it is tenotomised.
The bone surfaces at the top edge of your glenoid socket and at the planned graft insertion site on your humerus tuberosity are cleared of debris and freshened to optimise healing.
A very strong porcine graft is then secured in a bridge fashion across the gap between your socket and your humerus. It is attached firmly to your bones using strong suture anchors. The graft is then sutured side-to-side to your residual posterior rotator cuff tendon and muscle.
An animation of this procedure is available if you copy this link into your browser: https://www.arthrex.com/resources/animation/kwHmylIu6kyO_gFOq5hQVg/superior-capsular-reconstruction
You will go home either on the same day or the day after your operation. Please take your prescribed painkillers regularly for the first few days and start them before your nerve block wears off.
You can take down any bulky padded dressings on day 2, but keep your wounds covered with the waterproof dressings for 12 days. Showering is fine after four days with dressings on.
You will need to wear your sling for the first six weeks and to limit the motion across your graft repair site. The physiotherapists will give you advice on what you should and should not do. After six weeks you will progress to more active motion in your shoulder and you will begin to strengthen it from three months.
Patients vary in their symptoms after surgery, but in general you can expect to return to:
Office work (in a sling) after two or three weeks for many, but you may still be too sore
Light physical work after 12 weeks
Heavy labour or overhead sport will take 26 weeks
Driving is allowed once you are confident and competent to control a car both for routine and emergency manoeuvres. This is unlikely before 8 weeks.
You will be seen at two weeks after your operation. Depending on your progress, your on-going follow up will vary. Most patients can be discharged between by six months after surgery.
Emerging data for this procedure is very encouraging, especially as this problem (a young patient with irreparable rotator cuff tear) was previously hard to treat.
Patients are reporting significant improvements in active function and pain of their shoulders. As this is a relatively new technique, longer-term data are awaited and many patients are now enrolled in longitudinal studies to assess this.
Arthroscopic shoulder surgery is generally very safe, but specific risks of superior capsular reconstruction include:
Stiffness (5%) which occasionally requires further surgery
Lack of benefit (approx. 10-15%) - remember, it can take 9 months to gain the full benefit from this operation
Infection (1%) – Arthroscopic surgery is low risk for infection. The graft material used in the SCR is sterile just like any other implant. The porcine dermal cells have been removed during processing of the graft to minimize the reaction of your body to a foreign material. The chance of acquiring any viral or animal infection is minute. As with any rotator cuff repair, you will be given antibiotics at the time of your operation
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
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