Related Experiment Video
Updated: Jun 30, 2026
Modified Long Head of Biceps Tendon Rerouting and Fixation as Partial Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears
Published on: March 6, 2026
Biomechanical influence of surgical and graft-related factors in superior capsule reconstruction: A systematic review
Madalena Antunes1, Carlos Quental1, João Folgado1
1IDMEC Instituto Superior Técnico, Universidade de Lisboa Lisbon Portugal.
Purpose:
Arthroscopic superior capsule reconstruction (ASCR) is a surgical option for the treatment of irreparable rotator cuff tears. This systematic review aimed to synthesize the available biomechanical evidence on ASCR, especially on the influence of surgical and graft-related factors on shoulder biomechanics and graft mechanics. It was hypothesized that graft type, dimensions and concomitant procedures affect postoperative biomechanics following ASCR.
Methods:
A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Web of Science, Scopus, Cochrane Library and Ovid databases. Eligible studies included cadaveric, in vitro, in vivo and in silico biomechanical studies evaluating ASCR-related factors. Animal studies, clinical outcome studies and comparisons with alternative techniques were excluded.
Results:
A total of 37 biomechanical studies were included. Investigated factors comprised concomitant procedures (29.3%), graft type (26.8%), shoulder position of fixation (22.0%), graft thickness (12.2%) and fixation technique (9.8%). Most studies used cadaveric models (86.5%) under quasi-static conditions with simplified muscle-loading protocols and assessed outcomes at three to five shoulder positions in the frontal plane. Most studies focused on the spacer role of the graft in limiting superior humeral head translation, while its contribution to humeral head centring and dynamic force redistribution was overlooked. Fascia lata grafts were generally associated with improved joint stability and reduced subacromial contact pressures. The shoulder position of fixation influenced joint stability, and concomitant procedures were required to restore anterior-posterior stability. Substantial heterogeneity in experimental protocols, outcome measures and reporting practices limited a direct comparison across studies.
Conclusions:
The current biomechanical evidence on ASCR remains constrained by methodological simplifications and the isolated, rather than combined, assessment of ASCR-related factors. Available data suggest that graft type and dimensions, and the performance of concomitant procedures restoring capsule continuity, influence the recovery of joint stability.
Level Of Evidence:
Basic science study: biomechanics.
