Arthroscopic Superior Capsular Reconstruction by the Mini-Open Modified Keyhole Technique Using an Achilles Tendon–Bone Allograft

The treatment of massive and irreparable rotator cuff tears remains a challenge for shoulder surgeons. When treating patients with chronic rotator cuff tears, especially those with severe fatty degeneration, severe tendon retraction, or muscle atrophy, the risk of re-tear and persistent severe pain persists. Therefore, surgeons can choose from numerous options. Superior capsular reconstruction (SCR) was introduced as a technique to maintain the stability of the upper shoulder and stabilize the muscles without repairing the supraspinatus and infraspinatus. Various autograft and allograft techniques have been developed. SCR performed using an autograft has the disadvantage of requiring harvesting the tensor fascia lata. Although allografts reduce harvest time, they also increase donor-site morbidity and the time required for healing. To solve the healing problem, we have introduced an SCR technique through grafting with the Achilles tendon–bone. Although this is an unproven technique for patients with chronic irreparable rotator cuff tears, our short-term outcomes seem promising. Further studies and follow-ups are needed to determine the success of this technique.