Augmented Repair of Large to Massive Delaminated Rotator Cuff Tears With Autologous Long Head of the Biceps Tendon Graft: The Arthroscopic “Cuff-Plus” Technique

Abstract

An anatomic and tension-free repair is the goal of arthroscopic rotator cuff repair. However, this purpose is not always achievable in large and massive tears, and sometimes, even when intraoperative results seem acceptable, clinical and radiologic outcomes can be disappointing shortly afterward. Superior capsule reconstruction has been claimed as a valid and viable joint-preserving option for treating irreparable rotator cuff tears. However, the role of the superior capsule in repairable cuff tears has also been questioned. The aim of this article is to present the so-called arthroscopic cuff-plus technique. This technique consists of superior capsule reconstruction using the proximal part of the long head of the biceps tendon associated with a tension-free repair of the rotator cuff tendons in large to massive delaminated tears.

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].…”