* The rotator cuff itself acts as a dynamic stabilizer to the glenohumeral joint, resisting superior migration of the humeral head when the deltoid muscle contracts. In the coronal plane, the deltoid muscle and the supraspinatus tendon function as a coordinated couple, and in the transverse plane, the infraspinatus and teres minor (posterior) and subscapularis (anterior) tendons function to maintain a balanced force couple. * Superior capsular reconstruction works by providing the glenohumeral joint with a passive constraint to superior humeral-head translation, optimizing the otherwise dysfunctional rotator cuff force couples. * Superior capsular reconstruction is indicated in patients with intolerable pain and/or unacceptable dysfunction who have attempted and undergone failed nonoperative treatment, with massive, irreparable rotator cuff tears (typically involving supraspinatus and infraspinatus tendons), with minimal to no rotator cuff arthropathy (Hamada Grade 1 or 2), with an intact or reparable subscapularis tendon, and with a functional deltoid muscle. * Superior capsular reconstruction is contraindicated in patients with rotator cuff tears associated with moderate to severe rotator cuff arthropathy (Hamada Grade ≥3), patients with glenohumeral osteoarthritis, and patients with a torn or irreparable subscapularis. * Passing the acellular dermal allograft into the joint can be perhaps the most challenging aspect of the procedure, particularly in the setting of grafts of >35 mm in the anterior-posterior dimension. * Despite its rapid growth in popularity and several biomechanical studies evaluating the technique, clinical outcome literature for superior capsular reconstruction remains limited to date.
Copyright remains with the authors and publisher.
* The rotator cuff itself acts as a dynamic stabilizer to the glenohumeral joint, resisting superior migration of the humeral head when the deltoid muscle contracts. In the coronal plane, the deltoid muscle and the supraspinatus tendon function as a coordinated couple, and in the transverse plane, the infraspinatus and teres minor (posterior) and subscapularis (anterior) tendons function to maintain a balanced force couple. * Superior capsular reconstruction works by providing the glenohumeral joint with a passive constraint to superior humeral-head translation, optimizing the otherwise dysfunctional rotator cuff force couples. * Superior capsular reconstruction is indicated in patients with intolerable pain and/or unacceptable dysfunction who have attempted and undergone failed nonoperative treatment, with massive, irreparable rotator cuff tears (typically involving supraspinatus and infraspinatus tendons), with minimal to no rotator cuff arthropathy (Hamada Grade 1 or 2), with an intact or reparable subscapularis tendon, and with a functional deltoid muscle. * Superior capsular reconstruction is contraindicated in patients with rotator cuff tears associated with moderate to severe rotator cuff arthropathy (Hamada Grade ≥3), patients with glenohumeral osteoarthritis, and patients with a torn or irreparable subscapularis. * Passing the acellular dermal allograft into the joint can be perhaps the most challenging aspect of the procedure, particularly in the setting of grafts of >35 mm in the anterior-posterior dimension. * Despite its rapid growth in popularity and several biomechanical studies evaluating the technique, clinical outcome literature for superior capsular reconstruction remains limited to date.
Copyright remains with the authors and publisher.