Editorial Commentary: Shoulder Superior Capsular Reconstruction With Dermal Allograft Is Useful for Active Patients With Massive Irreparable Rotator Cuff Tear.

Shoulder superior capsular reconstruction (SCR) with dermal allograft improves clinical outcomes in active patients with massive irreparable rotator cuff tear. SCR functions to restore the glenohumeral joint position, including humeral head depression, thus improving contact pressures. SCR is best indicated in patients with lower grades of rotator cuff arthropathy (Hamada grades 1 and 2) who are <65 years old and without pseudoparalysis. However, SCR can be indicated in very active patients older than 65. In our experience, ≤70% of the times that a SCR surgery has been indicated, a direct complete repair of the supraspinatus tendon can be achieved during surgery. Thus, indications are narrow. Finally, optimal SCR graft tensioning is a complicated but a very important consideration. If the graft is unstressed, it won't function, and if it is too tight, it will tear.