Combined Superior Capsular Reconstruction Using Dermal Allograft and Biceps Tendon Autograft

Massive and irreparable rotator cuff tears remain a challenging problem in shoulder surgery, particularly in older patients with chronic pain and functional limitation. Superior capsular reconstruction has emerged as a reliable solution in cases in which traditional repair is not feasible. This technical note describes a superior capsular reconstruction technique combining a synthetic dermal allograft (Arthrex) and a long head of the biceps tendon autograft in a single construct to restore superior glenohumeral stability. The combination of these two biologic grafts enhances the mechanical strength and coverage of the reconstruction, allowing for improved graft tensioning and integration with native tissues. The technique uses a modified double-row construct to ensure secure fixation and optimal graft positioning. This combined graft approach may offer a durable and reproducible solution for managing irreparable rotator cuff tears in carefully selected patients.