Superior Capsular Reconstruction

Superior capsular reconstruction (SCR) of the shoulder has recently gained popularity as an option for joint-preserving shoulder surgery for patients with an irreparable rotator cuff tear. In the absence of glenohumeral arthritis, rotator cuff tear irreparability should only be diagnosed for most patients after a careful diagnostic arthroscopy. Superior capsular reconstruction adds biological, passive, superior constraint to the glenohumeral joint, thereby optimizing the rotator cuff force couples and improving joint kinematics. At short-term follow-up, SCR has been shown to be effective for pain relief and restoration of active shoulder motion, even in the worst cases of shoulder dysfunction (true shoulder pseudoparalysis). The rapid early adoption and expansion of SCR is justified by its excellent anatomical, biomechanical, and short-term clinical results. The techniques for arthroscopic SCR using dermal allograft continue to improve; however, the operation remains technically demanding. Patients with risk factors for irreparability and who might benefit from reconstruction of the superior capsule should be counseled about the operation as an additional, joint-preserving procedure that can be done in conjunction with arthroscopic, partial rotator cuff repair. [Orthopedics. 2017; 40(5):271-280.].