Background: Short-term clinical and radiographical results after surgical treatment of irreparable rotator cuff rupture with superior capsular reconstruction. A prospective study to examine the functional outcome and radiographical shoulder findings after superior capsular reconstruction using a porcine extracellular matrix dermal graft. Methods: Clinical results were evaluated using the Constant Score and Western Ontario Rotator Cuff Index over a 2-year follow-up period. Twenty-seven of 29 operated shoulders had magnetic resonance imaging of the injured shoulder after one year with a qualitative radiographic evaluation of graft integrity. Results: A total of 28 patients were operated with 29 superior capsular reconstructions. Over a 5-year period, 27 patients were included for a 2-year follow-up in which 24 patients completed. The mean age was 59 years at the time of surgery. At the final follow-up for 24 patients (mean 24 months) the mean Constant Score had improved from an average of 25.3 points to 56.5 points. The mean Western Ontario Rotator Cuff Index had increased from a percentage average of 30.2%-59.4%. Five out of 27 grafts were ruptured on follow-up magnetic resonance imaging. The clinical failure rate was 6 patients out of 28. Conclusions: No certain correlation between functional outcome scores and graft durability was found. No certain correlation between functional outcome and single tendon vs. 2 tendon defects was proven. There was a positive correlation between an inferior functional outcome and advanced stages of glenohumeral arthropathy. This study suggests that a superior capsular reconstruction can yield results that are comparable to other known salvage treatment options in patients with large-to-massive, irreparable rotator cuff defects with no significant cuff tear arthropathy. With these results, selected patients can be considered for treatment with superior capsular reconstruction rather than reverse shoulder arthroplasty, débridement, or tendon transfer.