Long Head of the Biceps as a Suitable Available Local Tissue Autograft for Superior Capsular Reconstruction: “The Chinese Way”

Abstract

Massive irreparable rotator cuff tears remain a challenging condition during daily clinical practice. Irreversible fatty infiltration of muscles and excessive chronic retraction of tendons predispose to high failure rates of their surgical treatment. Superior capsular reconstruction with either fascia lata autograft or a dermal allograft patch is a newly described solution that could prevent superior humeral head migration and restore the anteroposterior shoulder muscle force couples. The purpose of this article is to propose a technical modification of superior capsular reconstruction using long head of the biceps tendon autograft. The tendon's insertion into the glenoid is left intact, whereas laterally, it is tenotomized, transferred, and sutured with anchors onto the footprint of the supraspinatus tendon acting as a superior static stabilizer of the shoulder joint. Although this surgical modification has theoretical biological advantages, could be performed with the least technical demands, and simplifies the original demanding procedure, further prospective studies with large cohort populations and long-term follow-up are necessary to establish its effectiveness.

Arthroscopic superior capsule reconstruction using autologous fascia lata and biceps tendon augmentation

“…Currently, LHBT was considered as a suitable and locally available graft for SCR [20]. The intraarticular portion of LHBT was cut distally and xed to greater tuberosity by either suture anchors [20][21][22] or transosseous suture [23]. While LHBT was used to bridge superior glenoid and greater tuberosity similar to FL in SCR, general concerns in those techniques are regarding the size and quality of tendon graft.…”

Arthroscopic superior capsule reconstruction using autologous fascia lata and biceps tendon augmentation

“…Currently, LHBT was adapted as a suitable and locally available graft for SCR [18]. The intraarticular portion of LHBT was cut distally and xed to greater tuberosity by either suture anchors [18][19][20] or transosseous suture [21]. While LHBT was used to bridge superior glenoid and greater tuberosity similar to FL in SCR, general concerns in those techniques are regarding the size and quality of tendon graft.…”

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

“…Upon reviewing techniques related to rotator cuff repair with SCR, we found 2 published techniques that also yielded improved outcomes. The first technique was published by Boutsiadis et al 15 As in our technique, proximal LHBTs were transposed posteriorly, and tenotomy was done distally. Boutsiadis et al's technique was limited to irreparable RCTs, whereas our technique can be used for large to massive RCTs.…”

“…In Boutsiadis et al's work, the LHBT was transposed to cover the anterior footprint and was repaired side-to-side with the residual rotator cuff. 15 In our technique, the posteriorly transposed LHBT was sandwiched between the repaired rotator cuff and the footprint, and the LHBT was not fixed anterior to the repaired rotator cuff.…”