Introduction: Massive, irreparable rotator cuff tears are increasingly common and difficult to manage. Despite numerous treatment options, none provides superior long-term results, and no consensus exists with regard to the optimal surgical technique. Superior capsule reconstruction is a surgical treatment option that helps restore the native biomechanics of the glenohumeral joint by creating a passive restraint to superior subluxation. Partial rotator cuff repair in patients with a massive tear also has been shown to recreate shoulder kinematics and can be performed in combination with superior capsule reconstruction. This video describes a technique for arthroscopic superior capsule reconstruction with the use of a decellularized dermal allograft and concomitant partial rotator cuff repair.

Methods: The patient is positioned, and standard and accessory shoulder arthroscopy portals are created. Diagnostic arthroscopy is performed, and the supraspinatus tendon is interrogated to confirm that it cannot be repaired and that the humeral head can be reduced. Partial rotator cuff repair is then performed, if necessary, to restore the transverse force couples of the shoulder joint. The glenoid and humerus are prepared for suture anchor fixation, and the anchors are placed. The dimensions are measured, and the dermal allograft is cut and prepared to the appropriate size. The sutures are then passed through the graft, and the graft is prepared for insertion. The graft is inserted into the joint and secured to the glenoid and humerus. The graft is then sutured to the intact infraspinatus posteriorly in a side-to-side fashion to complete reconstruction of the superior capsule.

Results: This video presents a new technique for superior capsule reconstruction; therefore, limited clinical follow-up on the technique is available. However, the video discusses biomechanical and clinical results of other superior capsule reconstruction techniques.

Discussion and Conclusion: The described superior capsule reconstruction technique with the use of a decellularized extracellular matrix dermal allograft and concomitant partial rotator cuff repair is performed to restore the glenohumeral superior joint capsule, thereby re-establishing native shoulder contact pressures and translation. This reproducible technique, if performed anatomically, may allow for more aggressive rehabilitation protocols and earlier return to activity and may delay shoulder arthropathy and reconstruction surgery.