What it is
A repair reattaches your own torn tissue. Reconstruction is used when that tissue can no longer do its job: it rebuilds the structure with a graft, bone or nearby soft tissue. It may be considered for massive or irreparable rotator cuff tears (including tears of the subscapularis at the front of the shoulder), recurrent instability with bone loss from the socket or the ball, and shoulders that remain painful or unstable after earlier surgery.
Shoulder reconstruction is a special interest of Kasey Komperda, MD, FAAOS. His fellowship research, a biomechanical cadaveric study of reconstructive options for irreparable subscapularis tears involving the anterior capsule, was published in Arthroscopy in 2019. See publications.
Symptoms
- Persistent weakness lifting or rotating the arm
- Difficulty raising the arm overhead, even with effort
- A shoulder that keeps dislocating or feels as if it may slip out
- Pain or instability that continues after previous treatment or surgery
Diagnosis
A detailed examination assesses strength, motion and stability. MRI shows the quality of the tendons and muscles and how far a torn tendon has pulled back. CT is often used to measure bone loss in recurrent instability. If you have had surgery before, prior operative reports and imaging help explain why the shoulder has not recovered.
Treatment options
Non-surgical
- Physical therapy to strengthen the deltoid and remaining rotator cuff muscles
- Activity modification
- Anti-inflammatory medication or an injection in selected cases
Surgical
- Capsular reconstruction. A graft is used to rebuild the capsule at the top or front of the joint and restore stability.
- Bone block procedures, such as the Latarjet, rebuild bone lost from the socket in recurrent instability.
- Remplissage. An arthroscopic procedure for an engaging Hill-Sachs lesion, a dent in the back of the ball caused by dislocation that can catch on the rim of the socket. The nearby infraspinatus tendon and capsule are anchored into the dent so it can no longer engage. It is often combined with a Bankart (labral) repair.
- Revision surgery addresses the cause of a failed earlier repair or stabilization.
- When the joint is also arthritic, a reverse shoulder replacement may be the better reconstructive option.
Recovery
- First weeks
The shoulder is protected in a sling while the reconstruction begins to heal, typically for several weeks.
- Early rehab
Physical therapy restores motion step by step under close guidance.
- Strengthening
Strengthening follows once healing allows and progresses gradually under close guidance.
- Full recovery
Recovery is often longer than after a routine repair, commonly many months and sometimes up to a year or more.
Timelines are typical ranges, not guarantees. Recovery depends on the specific injury, the procedure, your health and your rehabilitation, and your plan is individualized.
Questions patients ask
What is the difference between repair and reconstruction?
A repair reattaches your own torn tissue. Reconstruction rebuilds the structure with a graft, bone or nearby soft tissue when the original tissue cannot be repaired.
What is a remplissage?
Remplissage is an arthroscopic procedure for an engaging Hill-Sachs lesion, a dent in the back of the ball of the shoulder caused by dislocation. The nearby infraspinatus tendon and capsule are anchored into the dent so it can no longer catch on the socket rim. It is often combined with a Bankart (labral) repair.
Can reconstruction help after a failed surgery?
Sometimes. A careful evaluation of why the earlier surgery did not succeed comes first, and the plan is built around that answer.
Is reconstruction done arthroscopically?
Some reconstructive procedures can be performed arthroscopically, others need an open incision, and some combine both. The approach depends on the procedure and your anatomy.
This page is general patient education and is not a substitute for an in-person evaluation.