Anterior Capsular Reconstruction with Human Dermal Allograft for Irreparable Subscapularis Tears

Anterior capsular reconstruction (ACR) using human dermal allograft (HDA) is an innovative surgical technique for managing irreparable subscapularis (SSc) tears. This procedure begins with patient positioning in the beach-chair configuration under general anesthesia, combined with an interscalene block for postoperative pain control. A deltopectoral approach is utilized, with an 8-10 cm incision extending from the coracoid tip to the deltoid tuberosity. After identifying and retracting the deltopectoral interval, the anterior glenoid is prepared by decorticating the bone surface to promote graft integration. Two suture anchors are placed at the 2- and 4-o'clock positions of the anterior glenoid. The HDA, measuring 50 mm × 40 mm and 3-4 mm in thickness, is folded into a double-layer configuration or used as a single layer based on the patient's requirements. The graft is secured with sutures to the glenoid anchors, with the arm positioned in neutral flexion, 30° abduction, and 30° external rotation for optimal tensioning. Additional fixation to the lesser tuberosity is achieved using a double-row suture bridge technique with anchors. For cases with a viable but retracted SSc tendon, augmentation over the graft is performed. Postoperative immobilization in an abduction brace is maintained for 6 weeks, followed by gradual rehabilitation. The precise graft fixation, tensioning, and structural support provided by this technique make ACR with HDA a valuable alternative to tendon transfers, preserving native shoulder biomechanics and offering a viable non-arthroplasty solution for severe anterior capsular deficiency.