Partial Rotator Cuff Repair With Biceps Rerouting and Double Tenodesis: An Efficient and Cost-Effective Biological...

Chronic rotator cuff tears (RCTs) are common and are often only partially repairable. Surgical treatment is challenging in younger patients. Surgical options include partial repair, tendon transfer, subacromial spacer, superior capsular reconstruction (SCR), and reverse shoulder arthroplasty. The use of SCR has been expanded and commercialized. The proposed techniques are complex using free avascular grafts and up to 7 anchors with associated increase in theater time and nonrefunded cost. Biceps SCR has shown promising biomechanical resistance and seems to offer a simple and cost-effective alternative.

Patients with RCTs (Goutallier stage ≥3, Patte 3) without arthritis that are at least partially repairable (infraspinatus and subscapularis) are candidates. Patients with mechanically intact long head of biceps (LHB) and superior labrum anterior to posterior (SLAP) anchor (minimal fraying of <10% and fraying of SLAP without full-thickness tears acceptable) are also candidates.

Key steps include arthroscopic release/lateral opening of the bicipital grove (15-20 mm) and placement of a first footprint anchor 8 to 10 mm posterior to the anatomical sulcus. Use of a 5-mm burr to create a new rerouting groove obliquely from the first anchor to the original groove, 15 to 20 mm caudal to the summit of the tubercle. Lasso-loop translation and tenodesis of the LHB to the first anchor. Use of a second caudal biceps tenodesis anchor with lasso-loops at the caudal end of the new groove. These 2 anchors create a rerouting bipedicle tenodesis performing the function of both an SCR and biceps tenodesis. Single-row, tension-free over-the-top repair of infraspinatus and the bursal layer of supraspinatus is completed with a third anchor on the rerouted biceps which remains in continuity.

The pilot series (n = 10) with a mean follow-up of 12 months (9-18 months) shows satisfactory outcomes. One patient developed a postoperative frozen shoulder and one a secondary Popeye deformity. Functional scores and patient satisfaction improved in all cases. The subjective shoulder value improved from a mean of 30% (10%-40%) preoperatively to 75% (60%-80%) postoperatively and the constant score from 30 points (20-40) to 68 points (60-71).

As long as LHB and its SLAP anchor are adequate, biceps rerouting in combination with partial rotator cuff repair is a safe alternative to time-consuming and expensive commercialized SCR techniques.