LAUSR

The rotator cuff (RC) plays a significant role in the glenohumeral joint function as a dynamic stabilizer of the joint since RC allows a full range of movement and provides stability. This demanding function renders RC tendons an ideal candidate for degenerative problems. The prevalence of RC tears in the general population is 34% and even higher in the elderly population exceeding 50% (Sher et al., 1995; Tempelhof et al., 1999). RC tears enlarge over time because RC muscles undergo atrophy and fatty degeneration (Yamaguchi et al., 2001). Surgical options for RC tears include debridement to latissimus dorsi tendon transfer and reverse total shoulder arthroplasty. When untreated, the natural course of disease eventually results in irreparable massive RC tears with irreversible muscle changes. On the other hand, RC tears are too complex to be treated with simple methods, and a patient can be too young to sacrifice the joint with arthroplasty (Ono et al., 2016). Therefore, indicating specific patient groups has become one of the most prevalent dilemmas and difficulties for shoulder surgeons in the last decades. Several authors proposed a novel but non-anatomic reconstructive approach to this old problem: reconstruction of the superior capsule (SCR). The method comprised of re-creating the lost glenohumeral dynamic stabilizer (rotator cuff) with a static restraint (the superior joint capsule) (Figure 1A) (Badhe et al., 2008; Mihata et al., 2013; Burkhart et al., 2016; Boutsiadis et al., 2017; Denard et al., 2018; Yildiz et al., 2019). The method was first proposed using tensor fascia lata (TFL) autograft, and time-zero mechanical success was proven in cadaveric studies (Mihata et al., 2012, 2013). Orthobiologics have been used in orthopedic surgery that is expected to have high biocompatibility and induce cell proliferation by enabling cells to attach to their surfaces (Toolan, 2006; Aurora et al., 2012; Mihata et al., 2012; Zhao et al., 2017; Bravo et al., 2018). Due to the donor site morbidity, acellular dermal matrix grafts (xenografts, allografts, autografts) and synthetic grafts were proposed as an alternative option. Fascia lata femoris is used as an autograft to care for RC tears by harvesting a band of fascia. Allografts are obtained from tendon tissues of human dermal origin; however, residual cells should be removed to avoid immune responses. On the other hand, allografts obtained depend on donors’ availability and tissue properties. Synthetic grafts can be categorized as degradable and non-degradable with superior strength, consistency, and durability (Ono et al., 2016). The xenografts are porcine-derived acellular dermal matrix scaffolds and were popularized as a low-cost alternative to the human-derived allografts (Barber, 2018; Flury et al., 2018; Kalina et al., 2019; Polacek, 2019; Ravenscroft et al., 2019). Today, the superiority of dermal xenografts is still debated because they are cheaper and easier to obtain. On the other hand, dermal Edited by: Jose Antonio Simoes, University of Aveiro, Portugal