Anterior Capsular Reconstruction With Proximal Biceps Tendon for Large to Massive Rotator Cuff Tears

Abstract

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.

Middle Trapezius Tendon Transfer for Augmentation of In Situ Superior Capsular Reconstruction–Reinforced Partial Rotator Cuff Repair: Short-term Outcomes of a Prospective Cohort Study

“…This choice might be further supported with different publications reporting favorable clinical, biomechanical, and histological outcomes of in situ SCR. 2 , 10 , 17 – 19 , 34 In an animal (rabbit) model, Xu et al 34 demonstrated time-dependent histologic remodeling (ie, dense, well-organized, mature collagen fibers) of the intra-articular portion and progressively ongoing healing of the extra-articular portion of the rerouted LHB. Besides, in comparison with its contralateral native counterparts, in situ SCR showed significantly more superior 9- and 12-week postreconstruction biomechanical performance (ie, higher load to failure and stiffness).…”

“…One technique is in situ/biological superior capsular reconstruction (SCR), which refers to transposition of the long head of the biceps (LHB) tendon out of its groove into a trough over the greater tuberosity where single-/double-row tenodesis of LHB is performed for structural and functional reconstitution of the superior glenohumeral (GH) capsule. 2 , 17 – 19 …”

“…When coupled with partial RC repair, in situ SCR has been reported to achieve satisfactory biomechanical (ie, static restraint of superior migration of the humeral head) and functional and radiological postoperative outcomes. 2 , 10 , 17 – 20 Nevertheless, in situ SCR has disadvantages in terms of its static biomechanical nature and inability to dynamically reconstitute supraspinatus (SSP) function. 2 , 5 , 10 , 17 – 20 , 37 …”

“… 2 , 10 , 17 – 20 Nevertheless, in situ SCR has disadvantages in terms of its static biomechanical nature and inability to dynamically reconstitute supraspinatus (SSP) function. 2 , 5 , 10 , 17 – 20 , 37 …”

“…2,[17][18][19] When coupled with partial RC repair, in situ SCR has been reported to achieve satisfactory biomechanical (ie, static restraint of superior migration of the humeral head) and functional and radiological postoperative outcomes. 2,10,[17][18][19][20] Nevertheless, in situ SCR has disadvantages in terms of its static biomechanical nature and inability to dynamically reconstitute supraspinatus (SSP) function. 2,5,10,[17][18][19][20]37 Kandeel 15 has recently introduced transfer of the medial portion of the middle trapezius tendon (MTT) as a novel technical note for dynamic reproduction of SSP function in patients with irreparable posterosuperior RC tears.…”