Arthroscopic Rotator Cuff Repair Combined With Modified Superior Capsule Reconstruction as Reinforcement by the Long Head of the Biceps

Abstract

In large or massive rotator cuff tears, successful repairs are difficult and complication rates are high, because the torn tendon is contracted and the superior capsule is disrupted. Recent studies have shown that superior capsule reconstruction (SCR) in massive irreparable rotator cuff tears results in better clinical scores and preserves stable glenohumeral stability without significant complications. In this article, we propose a simple, efficient SCR technique to reinforce the repair of large or massive rotator cuff tears. For this technique, the long head of the biceps tendon is used as a local autograft for the SCR, therefore eliminating comorbidities related to graft harvesting. The proximal part of the long head of the biceps tendon is transposed posteriorly and fixed onto the footprint as the SCR, which not only can maintain the stability of the glenohumeral joint, but also can preserve the vascular supply to help healing.

Superior Capsular Reconstruction of the Shoulder Using the Long Head of the Biceps Tendon: A Systematic Review of Surgical Techniques and Clinical Outcomes

“…Ten studies did not fulfill the inclusion criteria, leaving 13 studies for inclusion in the review ( Figure 1 ). Nine studies described relevant surgical techniques without clinical outcomes [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ], while the remaining four were clinical studies [ 2 , 24 , 25 , 26 ].…”

“…Nine studies described SCR using the LHBT without clinical outcomes and the dates of publication ranged between 2017 and 2020 [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Four studies were conducted in Asia [ 16 , 19 , 21 , 22 ], three in Europe [ 17 , 20 , 23 ], one in North America [ 18 ], and one included authors both from Asia and Europe [ 7 ].…”

“…Nine studies described SCR using the LHBT without clinical outcomes and the dates of publication ranged between 2017 and 2020 [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Four studies were conducted in Asia [ 16 , 19 , 21 , 22 ], three in Europe [ 17 , 20 , 23 ], one in North America [ 18 ], and one included authors both from Asia and Europe [ 7 ]. The indications of the procedure were irreparable [ 7 , 16 , 17 , 18 , 19 , 22 , 23 ] or repairable [ 20 , 21 ] RC tears, and most authors reported fatty infiltration up to Goutallier/Fuchs grade 4 [ 7 , 23 , 25 , 26 ].…”

“…Four studies were conducted in Asia [ 16 , 19 , 21 , 22 ], three in Europe [ 17 , 20 , 23 ], one in North America [ 18 ], and one included authors both from Asia and Europe [ 7 ]. The indications of the procedure were irreparable [ 7 , 16 , 17 , 18 , 19 , 22 , 23 ] or repairable [ 20 , 21 ] RC tears, and most authors reported fatty infiltration up to Goutallier/Fuchs grade 4 [ 7 , 23 , 25 , 26 ]. Several authors reported an intact or repairable subscapularis tendon as an indication [ 7 , 17 , 21 , 23 ].…”

“…The various options for the management of the LHBT are illustrated in Figure 2. A repairable tear of the RC was repaired using single-or double-row techniques including the LHBT in the repair [20,21]. For irreparable RC tears, partial repair of the remnants was performed with anchors and augmentation of the LHBT with side-to-side sutures [7,[16][17][18][19]22,23].…”