Superior Capsular Reconstruction With a Long Head of the Biceps Tendon Autograft: A Cadaveric Study

Abstract

Background:Several procedures have been proposed to address irreparable rotator cuff (RC) tears with pseudoparalysis. One recently proposed procedure is superior capsular reconstruction (SCR) using a tensor fasciae latae (TFL) autograft.Hypothesis:SCR with a locally available long head of the biceps tendon (LHB) autograft is biomechanically equivalent to SCR using TFL autograft for preventing superior humeral migration and the development of RC arthropathy in patients with irreparable RC tears.Study Design:Controlled laboratory study.Methods:Ten cadaveric shoulders (5 matched pairs) were tested. One shoulder from each pair was randomly assigned to the LHB reconstruction group using our novel technique, while the contralateral side was assigned to the TFL reconstruction group. SCR with a TFL autograft was performed based on previously described techniques. Massive RC tears were created by detachment of the supraspinatus and infraspinatus footprints from the greater tuberosity. The force required to superiorly translate the humerus 1.5 cm was then tested and recorded using a servohydraulic testing machine under 2 conditions: (1) after a massive RC tear and (2) after SCR with either a TFL autograft or an LHB autograft.Results:SCR with an LHB autograft required 393.2% ± 87.9% (P = .029) of the force needed for superior humeral migration in the massive RC tear condition, while SCR with a TFL autograft required 194.0% ± 21.8% (P = .0125). The LHB reconstruction group trended toward a stronger reconstruction when normalized to the torn condition (P = .059).Conclusion:SCR with an LHB autograft is a feasible procedure that is shown to be biomechanically equivalent and potentially even stronger than SCR with a TFL autograft in the prevention of superior humeral migration.Clinical Relevance:This new technique may help to prevent superior humeral migration and the development of RC arthropathy in patients with irreparable RC tears.

Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff Tears: Does It Make Sense? A Systematic Review of Early Clinical Evidence

“…TFL autograft, acellular dermal allograft, and long head of the biceps tendon autograft appear to be biomechanically viable options, but further clinical study is clearly needed. 10,15,25,29-32,41,42…”

“…TFL autograft, acellular dermal allograft, and long head of the biceps tendon autograft appear to be biomechanically viable options, but further clinical study is clearly needed. 10,15,25,[29][30][31][32]41,42 The ultimate question remains whether these clinical improvements in PRO and VAS scores are comparable with alternative treatments, such as RTSA or LDT, and whether these early positive outcomes will remain consistent in medium-and long-term studies. A systematic review on RTSA for irreparable MRCT showed an ASES score improvement of 30.8 to 42.1 and a Constant score gain of 28.4 to 35.9.…”

Editorial Commentary: Superior Labral Reconstruction for Superior Humeral Migration With Large or Massive Rotator Cuff Tears: Not a Paradigm Shift…Yet!

“…The biceps tendon has been reported for superior capsular reconstruction, [3][4][5][6] but not often for reconstruction of the superior labrum. However, it is widely recognized the glenoid labrum plays a primary role in anterior 7,8 and posterior shoulder instability.…”

Biceps Transposition for Biological Superior Capsular Reconstruction

“…Han et al, 3 using a cadaveric rotator cuff tear model, found that shoulders in which the biceps was used as the reconstructed superior capsule showed decreased subacromial peak contact pressures and shifted the humeral head inferiorly. El-shaar et al 4 analyzed 5 sets of matched cadaveric shoulders after a massive rotator cuff tear was created in each shoulder. An SCR was performed using a TFL autograft in one of the cadaveric shoulder pairs, and the biceps tendon was used to reconstruct the superior capsule in the matched contralateral shoulder.…”