Superior Capsular Reconstruction with Achilles Tendon Allograft

Superior capsular reconstruction (SCR) has become an increasingly popular choice in the treatment of massive, irreparable rotator cuff tears, pseudoparalysis, and in cases in which revision of previous rotator cuff repair is indicated. The SCR procedure is intended to restore the superior stabilizing forces of a deficient rotator cuff. This technique is accomplished by substituting an autograft or allograft between the superior glenoid and the greater tuberosity of the humerus, thus keeping the humeral head centered in the glenoid during shoulder forward flexion and abduction. Since its advent, numerous techniques have been described for this procedure. A fascia lata autograft was initially described; however, many surgeons in the United States have advocated for the use of a humeral dermal allograft. Yet, biomechanical studies have demonstrated elongation and thinning of this material. Thus, the Achilles tendon allograft may be an attractive choice for SCR, given its previous success with ligamentous and tendinous reconstructions. In this article, we present our technique of SCR using an Achilles tendon allograft.