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

Abstract

Background and Objectives: Superior capsular reconstruction (SCR) with the use of a fascia lata autograft or a dermal allograft is an established treatment in treating irreparable rotator cuff (RC) tears. The long head of the biceps tendon (LHBT) has been recently proposed as an alternative graft for SCR. The purpose of this study was to present the surgical techniques and clinical studies utilizing the LHBT for SCR. Material and Methods: Medline, Scopus, and the Cochrane library were searched for relevant studies up to December 2020. The primary outcomes were pain intensity improvement and the incidence of RC and LHBT graft retears. Secondary outcomes were functional scores and acromiohumeral distance (AHD) improvements. Results: Nine studies described surgical techniques of SCR using the LHBT, and four clinical studies reported the outcomes of the technique. The mean pain intensity improved from 4.9 ± 2.3 to 1.6 ± 1.5 in terms of the visual analog scale, exceeding the minimum clinically important difference for adequate pain relief. Significant improvements were also noted in functional scores and AHD. When compared with other repair techniques for massive RC tears, i.e., the double-row repair, the transosseous-equivalent technique with absorbable patch reinforcement, and the traditional SCR with a fascia lata autograft, there were no significant differences in pain and function improvements. Conclusion: SCR using the LHBT is a useful treatment option for massive RC tears; it is equally effective with the traditional SCR and other established techniques. It presents numerous advantages being a safe, easy, time-saving, and cost-effective method. The only precondition for the technique is the presence of an intact LHBT. Additional clinical trials are necessary to determine which treatment is superior for treating massive RC tears, as well as to evaluate the long-term results of the technique.

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

“…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.…”

“…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.…”

“… 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 bursa-augmented repairs have been described recently. 7 , 8 , 9 , 10 , 11 …”

Editorial Commentary: Anterior Cable Reconstruction for the Shoulder Superior Capsule: Time for “Indication Rounds”

“…Rhee et al 27 are putting the basic science 16 to the test. Their work 27 and that of others [29][30][31] are showing clinical success. As with the TOE experience after its introduction, in the face of new ACR techniques, we cannot overlook the need to discern what can be done versus when a procedure is indicated with what specific technique.…”

Assessing the accuracy of arthroscopic and open measurements of the size of rotator cuff tears: A simulation-based study

“…Therefore, accurate intraoperative measurement of the size of the rotator cuff tear is crucial. Especially in certain techniques such as superior capsule reconstruction, precise measurements of the tears’ dimensions are crucial for the correct sizing of the graft[ 10 - 12 ]. Previous studies have compared magnetic resonance imaging (MRI) measurements with arthroscopic evaluation, and focused on the MRIs ability to detect shoulder pathology in general, and not on the arthroscopic accuracy to evaluate the dimensions of different types of rotator cuff tears[ 13 - 15 ].…”