Editorial Commentary: Superior Capsular Reconstruction Works Biomechanically but Should Be Used Selectively for Genuinely Irreparable Tears

Abstract

Superior capsular reconstruction (SCR) has undergone extensive biomechanical and clinical study. Systematic review of biomechanical studies has shown that SCR functions to depress the humeral head and improve the glenohumeral register, which provides proof of concept. Clinical studies have shown the short-term effectiveness of SCR, but this is influenced by graft type and thickness, as well as surgical technique. These studies are mostly flawed because followup is brief, postoperative imaging is often lacking, and the results may not be generalizable. Multiple systematic reviews pooling the results of these various clinical studies have mostly produced diluted conclusions that are not clinically helpful. To date, there is a dearth of comparative studies to help guide the selection of SCR over other treatment options such as subacromial balloon spacer, partial repair with or without augmentation, tendon transfer, reverse shoulder arthroplasty, or even continued nonoperative care. Additionally, SCR is a salvage operation rather than an expedient alternative to careful mobilization of a rotator cuff tear for primary repair. Ultimately, large-scale, long-term imaging-based comparative clinical studies, rather than additional systematic clinical or biomechanical reviews, must provide the evidence needed to determine the precise indications and optimal technique for SCR.

Editorial Commentary: Clinical Improvements of Superior Capsular Reconstruction Are Not Due to Maintained Dynamic Acromiohumeral Distance

“…A number of biomechanical "time-zero" studies have supported the role of the native superior capsule and reconstruction to prevent superior migration of the humeral head with abduction and improve glenohumeral kinematics. 7,8 This humeral head depression or stabilization during range of motion is thought to be primarily the root of the clinical improvements seen in the short-and mid-term. However, this may be an oversimplication.…”