Massive rotator cuff tears (RCT) have traditionally been a challenging clinical problem for shoulder surgeons. A broad variety of treatment options have been proposed to address this problem, but outcomes have been as variable as the techniques themselves. Superior capsular reconstruction has been presented as a way to restore the restraining effect of the superior joint capsule and balanced force couples in massive tears of the superior rotator cuff. The purpose of this article is to propose a technical modification of the superior capsular reconstruction in large to massive RCT, and, especially in anterior L-shaped RCT, using the long head of the biceps tendon autograft to reinforce the weakest area of the anterior capsule, not as an augmentation of the rotator cuff, but as a static stabilizer of the humeral head, allowing the rotator cuff repair to heal without tension.

Massive irreparable rotator cuff tears (RCT) in younger and active patients remain a significant clinical challenge to orthopaedic surgeons. Superior capsular reconstruction (SCR) has been presented as a way to restore the restraining effect of the superior joint capsule and the balanced force couples necessary for dynamic shoulder function; furthermore, it does not exclude future treatment options. The purpose of this article is to show a technical modification of the SCR in massive and revision RCT using Achilles tendon allograft as an effective static restraint to prevent superior migration of the humeral head due to its thickness and robustness, and performing a side-to-side repair on the greater tuberosity between the graft and the residual infraspinatus tendon to completely restore the superior stability of the shoulder joint.