Editorial Commentary: Superior Capsular Reconstruction Is the Treatment of Choice for Massive, Irreparable Rotator...

The ideal treatment approach to massive, irreparable rotator cuff tears remains a hot topic of debate. In addition to joint-preserving methods including partial repair and subacromial spacer, techniques such as superior capsular reconstruction and tendon transfers are viable alternatives. These techniques are effective in providing pain relief and-to an extent-functionality during short-term follow-up; however, superior capsular reconstruction (SCR) appears to be the treatment of choice to address the pseudoparalysis.The relatively lower success rates of pseudoparalysis treatment in tendon transfers may be related to (1) the disturbance of the rotator cable, (2) the fact that a single transferred tendon alone may not be good enough to restore the impaired force-coupling mechanism required for overhead motion, and (3) to oppose the forces generated by the deltoid. On the other hand, the SCR graft functions both as a soft tissue augment that restores glenohumeral kinematics by re-establishing the force transmission between the remaining anterior and posterior portions of rotator cuff and as a static depressor of the humeral head during shoulder motion. With adequate graft quality, compatibility (i.e., fascia lata autograft), and thickness (minimum 5 mm), SCR may reliably maintain these functions. Tendon transfers are best reserved for the limited subgroup of patients where active external rotation loss is the primary concern. For the majority of patients with irreparable cuff tears, SCR remains the treatment of choice, particularly for patients with pseudoparalysis.