Editorial Commentary: Superior Capsular Reconstructions in Cases of Irreparable Rotator Cuff Tendons Only Partially Restore Anatomy, Yet Significantly Normalize Biomechanics-Without Resorting to Reverse Anatomy.

The goal of shoulder superior capsular reconstruction and/or anterior cable reconstructions, at least in terms of biomechanics, is to primarily restore a fulcrum to assist with pain control and functional optimization, with the secondary hope of maintaining cartilage. Fully restoring glenohumeral joint loads with SCR cannot be expected in the setting of persistent tendon insufficiency. Biomechanical studies characterizing shoulder capsular reconstructions have demonstrated anatomic and functional restorations toward normalization when tested with standard biomechanical methods. Glenohumeral abduction, superior humeral head migration, deltoid forces, and glenohumeral contact pressure and area, can be optimized toward the normal intact condition, as measured by motion tracking and pressure mapping in real time, using dynamic actuators. Insofar as restoring normal native anatomy is considered a fundamental priority, with the idea that joint functional longevity is enhanced by preserving anatomy, as surgeons, we should not lose sight of reconstruction over replacement (such as nonanatomic reverse total shoulder arthroplasty) as a favored goal. Anatomy-based reconstructions such as superior capsule or anterior cable reconstruction, may prove over time to be the best primary treatment as knowledge and innovations (technical and medical) develop, with nonanatomic arthroplasty truly being a last resort (yet a clinically viable option when indicated).