Editorial Commentary: Arthroscopic Superior Capsular Reconstruction Acts as a Biologic Spacer by Increasing...

Massive rotator cuff tears can be successfully treated with a wide variety of surgical procedures depending on many patient factors. The arthroscopic superior capsular reconstruction (SCR) is a good procedure for a younger patient with pseudoparesis, no lag signs, and a primary complaint of pain. How does the SCR work to achieve a good clinical outcome? One theory is that it restores the force couple and normal kinematics of the shoulder, but more evidence supports the theory that it acts as a biologic spacer. Differences in success of autograft versus allograft is likely due to graft thickness. Recent studies have shown that 6- to 8-mm fascia lata autograft has better outcomes than 2- to 4-mm dermal allograft. Improving the acromiohumeral distance and tissue healing to the tuberosity is important because this may prevent painful impingement. In our experience, when a patient has painful impingement and preserved motion or pseudoparesis, we will routinely offer a soft tissue procedure that can increase the acromiohumeral distance, acting as a spacer to prevent the greater tuberosity from contacting the acromion.