Editorial Commentary: Superior Labral Reconstruction for Superior Humeral Migration With Large or Massive Rotator Cuff Tears: Not a Paradigm Shift…Yet!

Large or massive rotator cuff tears are vexing clinical problems. Current treatment algorithms, while effective for many patients, are associated with failure of repair, persistent pain, and weakness including the inability to use the hand above shoulder level for some. Superior humeral migration associated with large or massive rotator cuff tears may lead to arthrosis or shoulder weakness. The biceps tendon has been reported for superior capsular reconstruction, but not often for reconstruction of the superior labrum. However, it is widely recognized the glenoid labrum plays a primary role in anterior and posterior shoulder instability. Therefore, degeneration of the superior labrum leading to superior humeral migration is plausible. Superior labral reconstruction merits exploration as a complementary procedure in addition to other procedures to center the humeral head in the glenoid.