Modified Superior Capsule Reconstruction Using the Long Head of the Biceps Tendon as Reinforcement to Rotator Cuff Repair Lowers Retear Rate in Large to Massive Reparable Rotator Cuff Tears

Chiang, Chen‐Yu; Shaw, Leo; Chih, Wei Hsing; Yeh, Ming Long; Ting, Hsiao Hsien; Lin, Chang Hao; Chen, Chao-Ping; Su, Wei-Ren

doi:10.1016/j.arthro.2021.04.003

Cited by 20 publications

(31 citation statements)

References 50 publications

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“…The LBT also provides a secondary restraint to superior migration similar to a superior capsular reconstruction, and possibly prevents retears in massive retracted tears. [2][3][4][5][6] The dense structure of the LBT further adds to the repair strength and prevents suture cut-out from the weak tendons. A prerequisite is the presence of an intact LBT and absence of severe fraying within the LBT tendon.…”

Section: Discussionmentioning

confidence: 99%

“…1 Superior capsular reconstruction in conjunction with tendon repair has also been described as an augmentation strategy in these difficult tears. [2][3][4][5][6] The use of subacromial bursa as a biological augmentation tissue has been evaluated in basic science studies, and arthroscopic techniques for bursaaugmented repairs have been described recently. [7][8][9][10][11] The purpose of this report is to present an arthroscopic technique for biologically augmented repair of massive retracted rotator cuff tears.…”

Section: Introductionmentioning

confidence: 99%

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Arthroscopic Biological Augmentation for Massive Rotator Cuff Tears: The Biceps-Cuff-Bursa Composite Repair

Bhatia

2021

Arthroscopy Techniques

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Surgical repair of massive and chronic rotator cuff tears is difficult due to tendon retraction and severe atrophy, and the resultant retear rate in the structurally weak tendons is high. Commercially available patches and bioinductive scaffolds have been used to provide strength and superior healing environment in partial and complete rotator cuff tears. Biological biceps autograft has been used for superior capsular reconstruction, and the subacromial bursa has been shown to have significant pluripotent stem cell potency for tendon healing. We describe our technique for combined use of the long biceps tendon (LBT) and vasculature-preserved subacromial bursa as autografts in rotator cuff repair augmentation. The technique involves obtaining a LBT graft of sufficient length using a "traction and tenodesis" technique. The subacromial bursa is mobilized as a continuous layer (vascular bursal duvet) by maintaining its medial and lateral vascularity. All-suture anchors are used to minimize the insertion apertures (3 mm) in tuberosity. The bursa is advanced laterally, and the mobilized cuff is repaired together as a biceps-cuff-bursa composite unit. Combined use of the biceps and bursa as biological autografts has the advantage of structural and regenerative augmentation, and the autografts are easily accessible without added cost.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Arthroscopic Biological Augmentation for Massive Rotator Cuff Tears: The Biceps-Cuff-Bursa Composite Repair

Bhatia

2021

Arthroscopy Techniques

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“…They found decreased humeral head translation, reduced subacromial contact pressure, and no impairment in total rotational range after LHBT rerouting both with and without RC repair ( 45 ). Improved clinical outcomes and low retear rates have been reported for this technique used as an adjunct to arthroscopic RC repair ( 14 , 49 , 50 ). However, data for an isolated biceps rerouting for MIRC’s are not available yet ( 14 , 49 , 50 ).…”

Section: Alternative Arthroscopic Techniques For Superior Humeral Hea...mentioning

confidence: 99%

Treatment options for massive irreparable rotator cuff tears: a review of arthroscopic surgical options

Hazra

Hanson

et al. 2023

EFORT Open Reviews

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While functional reconstruction of massive irreparable rotator cuff tears remains a challenge, current techniques aimed at recentering and preventing superior migration of the humeral head allow for clinical and biomechanical improvements in shoulder pain and function. Recentering of the glenohumeral joint reduces the moment arm and helps the deltoid to recruit more fibers, which compensates for insufficient rotator cuff function and reduces joint pressure. In the past, the concept of a superior capsular reconstruction with a patch secured by suture anchors has been used. However, several innovative arthroscopic treatment options have also been developed. The purpose of this article is to present an overview of new strategies and surgical techniques and if existing present initial clinical results. Techniques that will be covered include rerouting the long head of the biceps tendon, utilization of the biceps tendon as an autograft to reconstruct the superior capsule, utilization of a semitendinosus tendon allograft to reconstruct the superior capsule, superior capsular reconstruction with dermal allografts, and subacromial spacers.

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“…P lenty of surgical techniques have been developed to treat massive irreparable posterosuperior rotator cuff tear, including simple debridement, 1 margin convergence, 2,3 biceps graft, [4][5][6] partial repair, 7,8 medialized footprint, 9 superior capsule reconstruction (SCR) with autologous iliotibial band (ITB), or long head of the biceps (LHBT), [10][11][12][13] latissimus dorsi transfer (LDT), 14 and lower trapezius tendon (LTT) transfers with Achilles allograft 15,16 or hamstring autograft. 17 Among them, LHBT SCR has gained popularity recently because it is available locally, free of additional costs, less technically demanding, and normalizes superior migration and subacromial contact pressure because of the spacer effect provided by the LHBT.…”

mentioning

confidence: 99%

Arthroscopic-Assisted Lower Trapezius Tendon Transfer With Autologous Semitendinosus Tendon and Long Head of Biceps Superior Capsule Reconstruction for Massive Irreparable Posterosuperior Rotator Cuff Tears

Chiu

Yang

Tang

et al. 2022

Arthroscopy Techniques

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Modified Superior Capsule Reconstruction Using the Long Head of the Biceps Tendon as Reinforcement to Rotator Cuff Repair Lowers Retear Rate in Large to Massive Reparable Rotator Cuff Tears

Cited by 20 publications

References 50 publications

Arthroscopic Biological Augmentation for Massive Rotator Cuff Tears: The Biceps-Cuff-Bursa Composite Repair

Arthroscopic Biological Augmentation for Massive Rotator Cuff Tears: The Biceps-Cuff-Bursa Composite Repair

Treatment options for massive irreparable rotator cuff tears: a review of arthroscopic surgical options

Arthroscopic-Assisted Lower Trapezius Tendon Transfer With Autologous Semitendinosus Tendon and Long Head of Biceps Superior Capsule Reconstruction for Massive Irreparable Posterosuperior Rotator Cuff Tears

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