Commentary

The management of rotator cuff tears has evolved over the last several decades, however, it is still a challenging issue for treating surgeons because there has been no general consensus on surgical indications and management. More recently, biologic augmentation of rotator cuff repairs with different patches and/or scaffolds has increased in popularity. Superior capsular reconstruction (SCR) has been recently advocated as an alternative surgical option for patients with massive irreparable rotator cuff tears and this technique has been shown to have encouraging early outcomes. Various clinical studies have been reported in the literature, however there is still a lack of understanding regarding its biomechanical properties.

Geoffrey and co-authors have addressed this important scientific topic. Their cadaveric paper investigates an important clinical question regarding graft thickness in SCR and joint stability. The principal findings of the study are that the use of a double layered human dermal allograft (HAD) resulted in less superior translation compared to single layered HAD. Although this was a cadaveric study it provides guidance which can be used during surgery.

Thickness of the graft and initial stiffness are important features for graft integrity of SCR. A recent clinical study by Kholinne et al. ¹ showed that double layered fascia lata autograft augmented with polyprophyline mesh resulted in a good clinical outcome compared to fascia lata alone.

Martin Polacek et al. ² also did a study to evaluate the short-term clinical outcomes and the complications related to arthroscopic SCR using a 3-layered fascia lata autograft (FLA) reinforced with a non-absorbable suture mesh. Their conclusion was 83% of the 24 patients achieved minimal clinically important difference using a FLA reinforced with a suture mesh. The procedure had a complication rate of 17%.

Overall, this cadaveric study reminds us of the importance of graft thickness for a successful SCR and is therefore worth reading.