**7. Technique**

is a concern, as are functional limitations imposed by this surgery. Due to these limitations, reverse shoulder arthroplasty is typically reserved for patients in their 60s, 70s, and older [32].

The main reason to consider superior capsule reconstruction (SCR) is as an alternative to reverse shoulder arthroplasty or tendon transfers in patients with irreparable superior rotator cuff tears, with or without early cuff tear arthropathy. In this procedure a graft tissue is attached to the superior glenoid and the greater tuberosity, thereby spanning the superior aspect of the glenohumeral joint (**Figure 6**). The biomechanical rationale behind this surgery is debated. One proposed rationale is a tenodesis effect between the glenoid and the humeral head, which helps regain the stabilizing effect to the glenohumeral articulation normally conferred by the superior capsule and the rotator cuff [2]. This has been called the "reverse trampoline" effect. The other proposed mechanism is that the inserted graft acts a spacer between the humeral head and the underside of the acromion, essentially keeping the head depressed by

 **Figure 6.** Schematic drawing, showing a shoulder with a normal superior rotator cuff (A), a large and irreparable defect

of the superior cuff (B), and after a SCR (C and D).

**6. Rationale, indications, and contraindications for superior capsule** 

**reconstruction (SCR)**

136 Advances in Shoulder Surgery

Arthroscopic reconstruction using tensor fascia lata was initially proposed by Mihata et al. [2]. Several other authors have reported SCR using acellular dermal allograft [35–39]. An arthroscopic technique is typically used for this procedure, but an open technique may be used in cases of difficult arthroscopic exposure or for surgeons less familiar with arthroscopic techniques. We describe our preferred technique for arthroscopic superior capsular reconstruction.
