Superior Capsular Reconstruction Using Dermal Allograft Is a Safe and Effective Treatment for Massive Irreparable Rotator Cuff Tears: 2-Year Clinical Outcomes

Published:October 17, 2020DOI:


      To evaluate functional, symptomatic, and diagnostic imaging outcomes after arthroscopic superior capsular reconstruction (SCR) using dermal allograft in patients with massive irreparable rotator cuff tears.


      From 2015 to 2017, this multicenter study retrospectively evaluated patients undergoing arthroscopic SCR for treatment of symptomatic massive rotator cuff tears. Study criteria included the presence of a massive irreparable rotator cuff tear with retraction to the glenoid without diffuse bipolar cartilage loss, Grade 4 or 5 Hamada classification, and subscapularis pathology that could not be addressed. All SCR procedures were performed with neutral abduction of the arm at the time of implantation. Outcome measures included visual analog pain scale (VAS) score, the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and active forward elevation (FE) through 2 years postoperatively. Imaging analyses included radiographs, ultrasound, and magnetic resonance imaging at 6 months and 1 year.


      Fourteen patients met all study criteria including required follow-up. There were statistically significant improvements in VAS pain (3.3-0.6, P = .001), ASES (55.0-86.5, P < .0001), SANE (33.1-71.5, P < .0001), and active FE (128-172, P = .0005) with mean follow-up of 2.1 years. Twelve patients (86%) met the minimum clinically important difference in VAS pain, ASES, and SANE. Thirteen grafts (93%) had ultrasonographic evidence for vascularity by 1 year postoperatively. There were 2 graft complications (14%) with one (7%) requiring revision to reverse total shoulder arthroplasty.


      Arthroscopic SCR using dermal allograft can be a safe and effective treatment option for patients with massive irreparable rotator cuff tears with statistically significant improvements in VAS pain, ASES, SANE, and active FE at 2-years postoperatively, with 93% of grafts demonstrating vascularity at 1-year postoperatively. Neutral abduction of the arm at the time of implantation resulted in positive clinical outcomes and may decrease graft failure rate.

      Level of Evidence

      Level IV, case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bedi A.
        • Dines J.
        • Warren R.F.
        • Dines D.M.
        Massive tears of the rotator cuff.
        J Bone Joint Surg Am. 2010; 92: 1894-1908
        • Goutallier D.
        • Postel J.M.
        • Bernageau J.
        • Lavau L.
        • Voisin M.C.
        Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan.
        Clin Orthop Relat Res. 1994; 304: 78-83
        • Melis B.
        • Nemoz C.
        • Walch G.
        Muscle fatty infiltration in rotator cuff tears: Descriptive analysis of 1688 cases.
        Orthop Traumatol Surg Res. 2009; 95: 319-324
        • Melis B.
        • Wall B.
        • Walch G.
        Natural history of infraspinatus fatty infiltration in rotator cuff tears.
        J Shoulder Elbow Surg. 2010; 19: 757-763
        • Gerber C.
        • Maquiera G.
        • Espinosa N.
        Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears.
        J Bone Joint Surg Am. 2006; 88: 113-120
        • Sershon R.A.
        • VanThiel G.S.
        • Lin E.C.
        Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years.
        J Shoulder Elbow Surg. 2014; 23: 395-400
        • Ek E.T.
        • Neukom L.
        • Catanzaro S.
        • Gerber C.
        Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: Results after five to fifteen years.
        J Shoulder Elbow Surg. 2013; 22: 1199-1208
        • Mihata T.
        • Lee T.Q.
        • Watanabe C.
        • et al.
        Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
        Arthroscopy. 2013; 29: 459-470
        • Barber F.A.
        • Aziz-Jacobo J.
        Biomechanical testing of commercially available soft-tissue augmentation materials.
        Arthroscopy. 2009; 25: 1233-1239
        • Hirahara A.M.
        • Andersen W.J.
        • Panero A.J.
        Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up.
        Am J Orthop (Belle Meade NJ). 2017; 46: 266-278
        • Lee S.J.
        • Min Y.K.
        Can inadequate acromiohumeral distance improvement and poor posterior remnant tissue be the predictive factors of re-tear? Preliminary outcomes of arthroscopic superior capsular reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2205-2213
        • Denard P.J.
        • Brady P.C.
        • Adams C.R.
        • Tokish J.M.
        • Burkhart S.S.
        Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft.
        Arthroscopy. 2018; 34: 93-99
        • Pennington W.T.
        • Bartz B.A.
        • Pauli J.M.
        • Walker C.E.
        • Schmidt W.
        Arthroscopic superior capsular reconstruction with acellular dermal allograft for the treatment of massive irreparable rotator cuff tears: Short-term clinical outcomes and the radiographic parameter of superior capsular distance.
        Arthroscopy. 2018; 34: 1764-1773
        • Burkhart S.S.
        • Pranckun J.J.
        • Hartzler R.U.
        Superior capsular reconstruction for the operatively irreparable rotator cuff tear: Clinical outcomes are maintained 2 years after surgery.
        Arthroscopy. 2020; 36: 373-380
        • Catapano M.
        • de Sa D.
        • Ekhtiari S.
        • Lin A.
        • Bedi A.
        • Lesniak B.P.
        Arthroscopic superior capsular reconstruction for massive, irreparable rotator cuff tears: A systematic review of modern literature.
        Arthroscopy. 2019; 35: 1243-1253
        • Sochacki K.R.
        • McCulloch P.C.
        • Lintner D.M.
        • Harris J.D.
        Superior capsular reconstruction for massive rotator cuff tear leads to significant improvement in range of motion and clinical outcomes: A systematic review.
        Arthroscopy. 2019; 35: 1269-1277
        • Ekhtiari S.
        • Adili A.F.
        • Memon M.
        • et al.
        Sources, quality, and reported outcomes of superior capsular reconstruction: A systematic review.
        Curr Rev Musculoskelet Med. 2019; 12: 173-180
        • Hamada K.
        • Yamanaka K.
        • Uchiyama Y.
        • Mikasa T.
        • Mikasa M.
        A radiographic classification of massive rotator cuff tear arthritis.
        Clin Orthop Relat Res. 2011; 469: 2452-2460
        • Hirahara A.M.
        • Adams C.R.
        Arthroscopic superior capsular reconstruction for treatment of massive irreparable rotator cuff tears.
        Arthrosc Tech. 2015; 4: e637-e641
        • Cvetanovich G.L.
        • Gowd A.K.
        • Liu J.N.
        • et al.
        Establishing clinically significant outcome after arthroscopic rotator cuff repair.
        J Shoulder Elbow Surg. 2019; 28: 939-949
        • Hirahara A.M.
        • Lederman E.S.
        • Andersen W.J.
        • Yamashiro K.
        The evolution of the superior capsular reconstruction technique.
        International Congress for Joint Reconstruction. 2018, Mar 1; (Accessed July 5, 2020)
        • Scheiderer B.
        • Kia C.
        • Obopilwe E.
        • et al.
        Biomechanical effect of superior capsule reconstruction using a 3-mm and 6-mm thick acellular dermal allograft in a dynamic shoulder model.
        Arthroscopy. 2020; 36: 355-364
        • Mihata T.
        • McGarry M.
        • Kahn T.
        • Goldberg I.
        • Neo M.
        • Lee T.
        Biomechanical effect of thickness and tension of fascia lata graft on glenohumeral stability for superior capsule reconstruction in irreparable supraspinatus tears.
        Arthroscopy. 2016; 32: 418-426
        • Hirahara A.M.
        • Andersen W.J.
        • Panero A.J.
        Ultrasound assessment of the superior capsular reconstruction with dermal allograft: An evaluation of graft thickness and vascularity.
        Arthroscopy. 2019; 35: 3194-3202
        • Hartzler R.U.
        • Softic D.
        • Qin X.
        • Dorfman A.
        • Adams C.R.
        • Burkhart S.S.
        The histology of a healed superior capsular reconstruction dermal allograft: A case report.
        Arthroscopy. 2019; 35: 2950-2958
        • Samade R.
        • Jones G.L.
        • Bishop J.Y.
        Evaluation of an incorporated superior capsular reconstruction graft: A case report.
        JBJS Case Connector. 2019; 9e0378
        • Lacheta L.
        • Horan M.P.
        • Schairer W.W.
        • et al.
        Clinical and MRI outcomes after arthroscopic superior capsule reconstruction with human dermal allograft for irreparable posterosuperior rotator cuff tears a minimum two-year follow-up.
        Arthroscopy. 2020; 36: 1011-1019
        • Emerson C.P.
        • Balazs G.C.
        • Lee S.C.
        • Dines J.S.
        • Jose J.
        • Greditzer 4th, H.G.
        Magnetic resonance imaging of the failed superior capsular reconstruction.
        Clin Imaging. 2020; 60: 172-176