Editorial Commentary: Anterior Capsular Reconstruction for Subscapularis Deficiency: The Definitive Treatment or a Helpful Adjunct?

Abstract

Anterior glenohumeral instability in the setting of irreparable subscapularis deficiency represents a difficult clinical scenario for the treating shoulder surgeon. Anterior capsular reconstruction with humeral dermal allograft improved glenohumeral translation stability and range of motion to near-normal values whereas pectoralis major tendon transfer was unable to do so. However, placement of a static spacer does not restore the dynamic force couple or shoulder kinematics. Further research is needed to evaluate the functional outcomes using this reconstruction technique.

Combined Arthroscopic Superior and Anterior Capsular Reconstruction of the Glenohumeral Joint

“…T here has been increasing interest regarding the utility of superior capsular reconstruction (SCR) for restoration of static restraint in the young patient with a rotator cuff-deficient shoulder 1,2 . However, the value of anterior capsular reconstruction (ACR) for the irreparable or deficient subscapularis has been limited to small case series 3,4 , biomechanical studies [5][6][7] , and technique articles [8][9][10][11][12] . Gallagher et al recently described a combined anterior capsular augmentation and posterior capsular reconstruction with human dermal allograft for patients with multidirectional shoulder instability; however, to our knowledge, there are no other reports of combined capsular reconstructions.…”