Arthroscopic Rotator Cuff Repair Reinforced With Proximal Biceps Rerouting

Massive rotator cuff tears (RCTs) with significant retraction are challenging due to the high retear rates and limitations associated with existing repair techniques. Biceps tendon rerouting has recently emerged as an effective reinforcement technique for massive RCTs, particularly in achieving low retear rates.

Arthroscopic RCT repair with proximal biceps tendon rerouting is a viable option for nonarthritic, active patients with massive, retracted RCTs for whom nonoperative treatment has failed and the long head of the biceps tendon is intact.

The patient was placed in a lateral decubitus position with the arm in 10 lbs of traction. A diagnostic arthroscopy demonstrated a complete supraspinatus and infraspinatus tear with retraction to the glenoid, along with a frayed long head of the biceps tendon with an intact subscapularis tendon. The transverse humeral ligament was released to reroute the biceps tendon and anchor it 10 mm posterior to the bicipital groove. The rotator cuff was mobilized and sequentially repaired with medial-to-lateral advancement using 3 separate suture tapes passed through the supraspinatus, biceps tendon, and back through the supraspinatus to create a linked, reinforced construct. A horizontal mattress suture was placed posteriorly to reduce a posterior dog-ear soft tissue corner. The sutures were then tensioned and anchored on the greater tuberosity using 3 anchors.

Arthroscopic massive RCT repair with biceps tendon rerouting has shown favorable clinical outcomes. Significantly lower retear rates compared with arthroscopic repair alone, and clinical outcomes equivalent to those of superior capsular reconstruction with autograft have been demonstrated in the literature for this technique.In this technical report, our patient experienced complete pain relief and regained full strength, along with near-complete range of motion, within 6 months after surgery.

Biceps tendon rerouting in the setting of arthroscopic massive RCT repair is an effective surgical option in active individuals with an intact or minimally degenerated biceps tendon. This technique provides a cost-effective solution that offers additional mechanical support and supplies a rich autologous source of collagen to strengthen the repair.

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