Editorial Commentary: Decreased Superior Capsular Reconstruction Postoperative Graft Volume Is More Common in Patients With Advanced Rotator Cuff Arthropathy and Is Associated With Inferior Outcome: Cause or Effect?

Recent research has investigated the impact of graft condition on the outcomes of shoulder superior capsular reconstruction for irreparable rotator cuff tears. A decreased lateral graft volume compared with the medial graft volume is more common in patients with rotator cuff arthropathy and is associated with inferior clinical outcomes. This would suggest that aside from simply failing at the suture-graft junction, grafts with thinner lateral segments may exhibit diminished biomechanical strength over time. This may explain, in part, the discrepancy in outcomes between thinned grafts and grafts with preservation of tissue thickness. However, a significant association is also shown between grafts with lateral thinning and factors that portend worse clinical outcomes, including a higher Hamada grade, larger anteroposterior distance of the graft spanning the greater tuberosity, increased fatty infiltration in the infraspinatus and subscapularis muscles, and higher rate of subscapularis retears postoperatively. This would suggest that reductions in graft volume may be a product of worse initial pathology, which in and of itself may explain the worse postoperative outcomes. Thus, it remains unclear whether the findings represent cause or effect.