Editorial Commentary: Superior Capsular Reconstruction Employing Allograft Heals and Functions Well if the Graft Is Sufficiently Thick and Stiff

Abstract

Superior capsular reconstruction (SCR) has fallen into disrepute, and the numbers performed appear to be on the decline because it is technically demanding and time-consuming, requires a long postoperative recovery, and does not always heal or function as expected. In addition, two "new kids on the block," the subacromial balloon spacer and the lower trapezius tendon transfer, have emerged as viable alternatives for low-demand patients who cannot tolerate a lengthy recovery and for high-demand patients who lack external rotation strength, respectively. However, carefully selected patients continue to do well after SCR, when surgery is meticulously performed using a graft that is sufficiently thick and stiff. The clinical results and healing rates after SCR using allograft tensor fascia lata are comparable with those after SCR using tensor fascia lata autograft and without donor-site morbidity. Robust comparative clinical study is needed to sort out the optimal graft type and thickness for SCR and the precise indications for each of the surgical treatment options for the irreparable rotator cuff tear, but let's not "throw the baby out with the bathwater" and abandon SCR altogether.