Superior Capsular Reconstruction of the Shoulder Using the Long Head of the Biceps Tendon: A Systematic Review of Surgical Techniques and Clinical Outcomes

Abstract

Background and Objectives: Superior capsular reconstruction (SCR) with the use of a fascia lata autograft or a dermal allograft is an established treatment in treating irreparable rotator cuff (RC) tears. The long head of the biceps tendon (LHBT) has been recently proposed as an alternative graft for SCR. The purpose of this study was to present the surgical techniques and clinical studies utilizing the LHBT for SCR. Material and Methods: Medline, Scopus, and the Cochrane library were searched for relevant studies up to December 2020. The primary outcomes were pain intensity improvement and the incidence of RC and LHBT graft retears. Secondary outcomes were functional scores and acromiohumeral distance (AHD) improvements. Results: Nine studies described surgical techniques of SCR using the LHBT, and four clinical studies reported the outcomes of the technique. The mean pain intensity improved from 4.9 ± 2.3 to 1.6 ± 1.5 in terms of the visual analog scale, exceeding the minimum clinically important difference for adequate pain relief. Significant improvements were also noted in functional scores and AHD. When compared with other repair techniques for massive RC tears, i.e., the double-row repair, the transosseous-equivalent technique with absorbable patch reinforcement, and the traditional SCR with a fascia lata autograft, there were no significant differences in pain and function improvements. Conclusion: SCR using the LHBT is a useful treatment option for massive RC tears; it is equally effective with the traditional SCR and other established techniques. It presents numerous advantages being a safe, easy, time-saving, and cost-effective method. The only precondition for the technique is the presence of an intact LHBT. Additional clinical trials are necessary to determine which treatment is superior for treating massive RC tears, as well as to evaluate the long-term results of the technique.

Keywords: arthroscopy; long head of biceps; rotator cuff; shoulder; superior capsular reconstruction.

Figure 1

Flow diagram for study selection process.

Figure 2

Illustration of the various LHBT (long head of the biceps tendon) management options. Red circles represent suture anchors, blue circles knotless anchors, and green lines suture tapes. (A) Fixation to the greater tuberosity and simple tenotomy; (B) Fixation to the greater tuberosity and tenodesis; (C) Fixation to the greater tuberosity, LHBT left intact into the bicipital groove; (D) Fixation to the greater tuberosity, LHBT left intact and rerouted in new groove; (E) Fixation to the greater tuberosity, LHBT left intact and rerouted, additional fixation of the LHBT to the anterior footprint; (F) double-bundle LHBT autograft and tenodesis; (G) triple-bundle LHBT autograft and tenodesis.