Advances in Arthroscopic Superior Capsular Reconstruction of the Shoulder: A Narrative Review

Irreparable massive rotator cuff tear (IMRCT) is a significant challenge in shoulder surgery, with traditional treatments yielding suboptimal outcomes. Superior Capsular Reconstruction (SCR), an innovative arthroscopic joint-preserving procedure, provides a new solution for IMRCT by restoring superior glenohumeral joint stability.

This narrative review systematically searched PubMed, Web of Science, Embase and Cochrane Library for arthroscopic SCR studies using the terms "superior capsular reconstruction", "irreparable massive rotator cuff tear", "arthroscopy" and "graft material". The search covered 2013 (the first SCR report) to 2025. Peer-reviewed English full-text articles were included, and duplicate, low-quality and irrelevant literatures were excluded. Finally, 45 high-quality studies (clinical cohort, biomechanical experiments, systematic reviews) were selected to analyze SCR advances in indications, graft selection, surgical techniques and rehabilitation.

SCR effectively improves shoulder function, alleviates pain and increases acromiohumeral distance (AHD) in IMRCT patients without severe glenohumeral arthritis. Tensor fascia lata autograft has the best long-term survival but donor-site morbidity risk; acellular dermal matrix allograft avoids donor-site injury but has high cost and slow integration; long head of the biceps tendon autograft is ideal for small-to-medium tears due to minimal invasiveness and cost-effectiveness. Hamstring and peroneus longus tendon grafts have specific clinical applications.

SCR is an effective IMRCT treatment, with individualized graft selection based on patient conditions, cost-effectiveness and regional availability being critical. Future research should establish SCR technical standards, evaluate long-term outcomes, refine patient selection and explore biologic augmentation and 3D-engineered grafts.