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Updated: Jan 16, 2026
Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft
Published on: June 6, 2025
Retrospective study on biceps tendon rerouting and local grafting with coracohumeral ligament for massive rotator
Yueh-Cheng Tsai1, Ping-Hung Lin2, Cheng-Han Ho3
1Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
Background:
Surgical management of massive irreparable rotator cuff tears remains difficult. We propose a novel method applied to the Taiwanese patient population: a mini-open, partial superior capsular reconstruction with rerouting of the long head of the biceps tendon and complete rotator cuff repair with the coracohumeral ligament (CHL) as a local graft to improve functional and radiological outcomes after the repair of massive rotator cuff tears.
Methods:
Between July 2020 and October 2022, 95 patients with rotator cuff tears were evaluated, and 11 patients met the inclusion criteria. These 11 patients with symptomatic large-to-massive rotator cuff tears, whose irreparability was confirmed during surgery, underwent this technique and were retrospectively followed up. Preoperative and postoperative acromiohumeral distances, Hamada classification, shoulder range of motion, pain score, and Constant score were compared to evaluate functional and radiographic outcomes.
Results:
The minimum follow-up period was 1 year (average, 22 months). One-year postoperatively, significant improvements were noted in range of motion. The Constant score significantly increased from 45.2 preoperatively to 79.3 at the one-year follow-up. Acromiohumeral distance measured on plain film showed a significant increase 12 months after surgery. No retears were detected on MRI scans conducted 6-12 months post-surgery.
Conclusion:
When treating irreparable massive rotator cuff tears in the Taiwanese patient population, applying this technique with CHL augmentation improves the clinical and radiographic outcomes without clinical donor-site morbidities. In our study, CHL harvesting in Taiwanese patients is safe and effective in the short term, offering a simple alternative to other graft sources.
