Editorial Commentary: Anterior Cable Reconstruction for the Shoulder Superior Capsule: Time for “Indication Rounds”

Anterior cable reconstruction (ACR) techniques for the superior capsule are multiple and varied. To optimize patient outcomes, technical considerations must be supported by basic science, both anatomically and biomechanically. ACR was designed to treat only partially repairable rotator cuff tendon tears, to provide a static support to a dynamic partial (and therefore "nonanatomic") repair, and to treat tears that could not be treated by transosseous-equivalent footprint-restoring "anatomic" repairs (both capsule and tendon repaired), but were also not so large as to necessitate superior capsule reconstruction. ACR allows restoration of posterosuperior capsular function with side-to-side repair sutures, and much of the biomechanical functionality comes from using whatever inherent native superior capsule is available. Cable reconstructions should be secured to normal attachment sites on the glenoid and greater tuberosity sulcus. Also, graft tension must be accounted for when considering humeral motion such as rotation and adduction. The indications for ACR need to be carefully considered and account for both anatomic and biomechanical rationales. In the face of new ACR techniques, the need to discern what is possible versus what procedure is indicated cannot be overlooked.