Arthroscopic In Situ Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon

Abstract

Large to massive rotator cuff tears are challenging to repair, although there are several options for dealing with them. Among them, superior capsular reconstruction was recently introduced as an effective procedure for retaining the static stability of the shoulder joint and preventing the progression to cuff tear arthropathy. The purpose of this technique-based article is to describe a surgical option, called arthroscopic in situ superior capsular reconstruction, for large to massive rotator cuff tears using the long head of the biceps tendon.

Fig 1

Subacromial space of right shoulder viewing from the posterior portal (A). The extent of the tear was measured by a laser-marked probe. (B) To make the LHBT mobile and reroute the tendon posterolaterally, removal of the soft tissue around the LHBT, including the transverse humeral ligament, was performed with an electrocautery device (Vapr Suction Electrodes; Depuy Synthes Mitek). (C) The bone bed of the greater tuberosity of the humeral head was prepared through the anterolateral portal with careful use of a bone cutter blade (4.2-mm Tiger Sterling Arthroscopy blade; ConMed). (LHBT, long head of biceps tendon; SSP, supraspinatus tendon.)

Fig 2

(A) The mobility and integrity of the LHBT should be checked by a tendon grasper. (B) Trial to reposition the LHBT posteriorly to the greater tuberosity of the humeral head was performed by a retriever. (LHBT, long head of biceps tendon.)

Fig 3

(A) Lateral anchor insertion (5.5-mm Healicoil; Smith & Nephew) at the midlateral portion of the footprint for LHBT fixation was performed. (B) A suture hook (Linvatec) which was preloaded with No. 1 PDS (Ethicon) was introduced through the anterior portal to make a lasso-loop tie and then was passed through the body of the LHBT. (C) One lasso-loop tie was made at the lateral anchor. (D) Two more wrap-around ties were made to ensure LHBT fixation after making the lasso-loop tie. (LHBT, long head of biceps tendon.)

Fig 4

(A) At the junction of joint cartilage and the footprint, the insertion of medial side anchor was performed. (B) One lasso-loop tie and two wrap-around ties were then made for the medial fixation of the LHBT. (LHBT, long head of biceps tendon.)

Fig 5

(A) An additional anchor can be inserted posterolaterally into the greater tuberosity of the humeral head just behind the LHBT for repair of the posterior rotator cuff. (B) The sutures from the two previously inserted anchors that serve to fix the LHBT can be used to repair the rotator cuff. (LHBT, long head of biceps tendon.)

Fig 6

Compared with preoperative radiograph (A), immediate postoperative radiograph (B) showed that humeral head migrated inferiorly about 7 mm.