Superior Capsular Reconstruction With Double Bundle of Long Head Biceps Tendon Autograft: The “Box” Technique

Abstract

The superior capsular reconstruction (SCR) is an arthroscopic surgical technique recently introduced as an effective solution to restore the defect of superior articular capsule in massive rotator cuff tears that cannot be repaired anatomically. The SCR retains static stability and inhibits the proximal humeral migration, thereby optimizing the force couples about the shoulder. In this surgical technique paper, we present our technique of SCR using a double bundle construct of long head of biceps tendon, called the “box” technique. It is always combined with partial rotator cuff repair.

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 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 ]. Contraindications were osteoarthritis of the glenohumeral joint, shoulder stiffness, deltoid muscle atrophy or axillary nerve injury, and lesions of the LHBT, i.e., severe tendinitis, partial tear >20% of its substance, and superior labrum anterior to posterior (SLAP) lesion III-IV [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ].…”