54F Chronic Shoulder Pain s/p RCR x 2, MRI, Please Help

Diego Lemos answered my question brilliantly:

That’s probably a bridging graft, a technique that is used in some places
for “irreparable tears”; the difference with a SCR, as you pointed out, is
that the graft proximally is attached to the stump of the chronically
retracted cuff stump, not to the glenoid such as in SCR. In your current
case, I do believe there is a full-thickness midsubstance tear of the graft
proximal to its humeral insertion but distal to its cuff attachment, while
sometimes sutures of the graft to the anterior and posterior cuff can give
you apparent “pseudotears” this looks too wide and irregular. The other
possibility is that instead of a bridging graft this was an augmentation
graft that failed versus a variation technique of the above, I do however
favor the first possibility. Regardless, the construct is insufficient as
the humeral head is significantly translated superiority with narrowing of
the acromiohumeral interval, but you already knew that 🙂 🙂 🙂

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Mohammad Samim was kind enough to share examples of a normal intact
superior capsular reconstruction on MRI, and examples of both glenoid and
humeral side attachment failure[image: SCR 2.jpeg][image: SCR Mohammad
Samim1.jpeg][image: SCR 3.jpeg][image: SCR 4.jpeg]

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