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Check out our new technique involving both a biceps transfer and superior capsular reconstruction.
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
This video demonstrates Dr. Grant Garcia’s clinical evaluation and surgical approach for a Superior Capsular Reconstruction (SCR). This advanced technique is specifically indicated for patients presenting with massive, chronic, and completely irreparable rotator cuff tears who want to avoid or delay a reverse total shoulder replacement.
When a massive rotator cuff tear leaves the top of the humeral head exposed, the upper arm bone pathologically migrates upward (superior translation) against the acromion during movement, leading to severe dysfunction and pain. The SCR procedure biomechanically re-centers the shoulder joint.
The procedure centers around these key surgical phases:
- Joint Debridement & Preparation: Dr. Garcia arthroscopically enters the subacromial space to debride scar tissue, remnants of the destroyed supraspinatus tendon, and subacromial bursa. He prepares a bleeding bone footprint along both the top of the shoulder socket (superior glenoid) and the upper arm bone (greater tuberosity) to maximize potential biological bonding.
- Graft Sizing & Introduction: Because there is no native tendon left to bridge the gap, a thick dermal allograft patch (typically an ArthroFLEX dermal matrix) is measured to perfectly match the patient's missing structural anatomy and introduced into the joint via a high-flow cannula.
- Medial & Lateral Fixation: Suture anchors are placed along the upper glenoid rim to securely bind the medial edge of the graft. On the humerus side, Dr. Garcia uses a double-row construct (frequently utilizing a knotless SpeedBridge layout) to compress the lateral edge of the graft firmly down across the greater tuberosity footprint.
- Kinematic Restoration: Tensioning the graft from the socket directly across to the arm bone recreates a static upper barrier. This biomechanical "roof" prevents the humeral head from sliding upward during muscle contraction, enabling the surrounding intact musculature (like the deltoduct and subscapularis) to effectively raise and rotate the arm.
The final visualization shows a perfectly stabilized humeral head capped by a taut, secure dermal matrix bridge that smoothly interfaces within the subacromial space to eliminate painful bone-on-bone impingement.
