Superior Capsular Reconstruction With the Addition of an Acromial Acellular Dermal Allograft Spacer

Superior capsular reconstruction has emerged as a promising technique in the treatment of massive irreparable rotator cuff tears. The technical aspects of the surgery continue to evolve, and scientific studies to evaluate these techniques are emerging. One such area of interest concerns the appropriate thickness of the graft and its role as a spacer. The original description of the graft was an autograft tensor fascia lata, which was folded to achieve a thickness of around 8 mm. It has been demonstrated that an 8-mm graft is superior biomechanically to a 4-mm graft, which exceeds the typical human dermal allograft thickness. Herein we describe a technique in which an acellular human dermal allograft was used to perform a superior capsular reconstruction and the remainder of the graft was used to resurface the undersurface of the acromion. This modification of the technique allows for arthroscopic acromial resurfacing, as well as effectively doubling the thickness of the spacer function of the graft. The technique and justification are described in detail, and this has become the senior author's standard approach to the massive irreparable rotator cuff tear in patients with Hamada stages 2 and 3.