Superior capsular reconstruction of the shoulder: the ABC (Arthroscopic Biceps Chillemi) technique

Superior capsular reconstruction (SCR) demonstrated its efficacy as a treatment option available in patients affected with irreparable posterosuperior rotator cuff tears without any signs of arthritis. Originally, the fascia lata autograft was fixed medially to the glenoid (with two or more anchors) and laterally to the greater tuberosity (with a compression double-row technique using four anchors or three transosseous tunnels). Additionally, side-to-side sutures were used to anteriorly and posteriorly connect the graft to the native residual rotator cuff tissue. However, the fascia lata as an autograft has a disadvantage related to the donor-site morbidity. To solve this aspect, allografts were employed with initial promising results. Nowadays, SCR is to be considered a technically demanding and expensive procedure, because of the cost of the allograft plus that of all the anchors employed to fix it. The Arthroscopic Biceps Chillemi's technique addresses these concerns in performing SCR and presents numerous advantages being a safe, easier, time and cost-saving way compared to the other published techniques. This technique has only one conditio sine qua non: the presence of the long head of the biceps tendon (LHB), used as an autograft. This condition may be interpreted as a disadvantage of this procedure in the presence of some anatomic variations of the intra-articular portion of the LHB and the very rare absence of the tendon or in case of partial or complete rupture of the LHB tendon associated with a rotator cuff tear.