Tensionable Knotless Tendon-Sparing Biceps Rerouting Technique for Irreparable Rotator Cuff Tears

This technique describes a tensionable knotless tendon-sparing biceps rerouting for superior capsular reconstruction using the long head of the biceps in irreparable supraspinatus tears. The long head of the biceps is arthroscopically released from the bicipital groove, rerouted over the greater tuberosity footprint, and secured with 2 self-punching, double-loaded knotless all-suture anchors, creating tensionable loops that stabilize both the long head of the biceps and infraspinatus or anterior cuff remnants. Medial side-to-side sutures further enhance reduction and stability. This technique preserves the tendon, avoids perforation of the tendon tissue, and eliminates the need for graft harvesting or bone tunnels. The approach is reproducible, minimally invasive, and suitable for degenerative or inflamed tendons, providing biomechanical stability and improved functional outcomes. Diligent patient selection remains critical for optimal results.