Modified Long Head of Biceps Tendon Rerouting and Fixation as Partial Capsular Reconstruction for Massive Irreparable...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• Massive irreparable rotator cuff tears (MIRCTs) pose significant surgical challenges due to fatty infiltration, tendon retraction, and tissue degeneration.
• Existing surgical treatments for MIRCTs have high failure rates.
• The long head of the biceps tendon (LHBT) has been explored for shoulder stabilization and strength restoration.

Purpose of the Study:

• To propose and describe a technical modification of capsular reconstruction using arthroscopic LHBT rerouting and fixation for MIRCTs.
• To enhance the repair of MIRCTs by stabilizing the humeral head and improving muscle strength.
• To reduce graft wear and improve healing in rotator cuff repair.

Main Methods:

• Arthroscopic exposure of the native bicipital groove after full rotator cuff release.
• Creation of a new groove in the greater tuberosity.
• Rerouting and secure fixation of the LHBT into the new groove.
• Completion of a side-to-side rotator cuff repair over the LHBT.

Main Results:

• The technique offers a method to reduce sharp graft angulation ('killer turn'), minimizing graft wear.
• Improved humeral head depression effects are observed.
• The newly created groove promotes healing between the LHBT and the greater tuberosity.
• Lowered risk of retear after rotator cuff repair.

Conclusions:

• This modified arthroscopic LHBT rerouting and fixation technique is a safe and effective option for managing MIRCTs.
• The procedure enhances rotator cuff repair by reducing graft wear and improving biomechanical stability.
• This technique provides a valuable new approach for complex shoulder reconstruction, potentially improving long-term patient outcomes.