Related Experiment Video
Updated: Aug 5, 2026
Modified Long Head of Biceps Tendon Rerouting and Fixation as Partial Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears
Published on: March 6, 2026
Both Rerouted and In Situ Biceps Superior Capsular Reconstruction Augmentation During Arthroscopic Rotator Cuff
Chang Hee Baek1, Bo Taek Kim1, Gustavo A Gil Noriega2
1Department of Orthopaedic Surgery Yeosu Baek Hospital Jeollanam-do Republic of Korea.
Purpose:
To evaluate the clinical and radiologic outcomes at a 2-year follow-up of arthroscopic rotator cuff repair (RCR) augmented with superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT) in patients with reparable posterosuperior rotator cuff tears.
Methods:
This retrospective, multicenter study included patients who underwent arthroscopic RCR with LHBT-based SCR at 2 institutions: Center A (October 2020 to March 2023) and Center B (June 2022 to July 2024), with a follow-up of 2 years. Indications included reparable supraspinatus and/or infraspinatus tears with Patte stage 2-3 retraction and Goutallier grade 3-4 fatty infiltration. Patients underwent RCR with either in situ LHBT fixation (Center A) or rerouted LHBT fixation to the center of the greater tuberosity (Center B). Exclusion criteria included prior shoulder surgery, infection, irreparable subscapularis tear, or loss to follow-up. Clinical outcomes were assessed using the visual analog scale, American Shoulder and Elbow Surgeons score, and range of motion. Radiologic evaluation included acromiohumeral distance, Hamada grade, and repair integrity via ultrasound or magnetic resonance imaging.
Results:
After excluding 10 patients, 58 were included (N = 26, Center A; N = 32, Center B), and their 2-year clinical outcomes were compared. Visual analog scale improved from 5.9 ± 1.5 to 2.1 ± 1.3, and American Shoulder and Elbow Surgeons score from 41.2 ± 10.0 to 73.6 ± 12.7 (P < .001). Minimal clinically important difference was achieved in 96.5% (visual analog scale) and 94.8% (American Shoulder and Elbow Surgeons). Range of motion improved significantly in forward elevation, abduction, and external rotation. Acromiohumeral distance (increased from 8.1 to 9.0 mm [P < .001]) with no progression in Hamada grade. Both centers showed comparable improvements with no significant differences in outcomes between techniques.
Conclusions:
Arthroscopic RCR augmented with SCR using the LHBT resulted in significant improvements in pain, function, and range of motion at the 2-year follow-up in patients with reparable rotator cuff tears. Both in situ and rerouted LHBT-based SCR techniques produced comparable clinical and structural outcomes, with no significant differences observed between the 2 methods, with the potential for type II error due to low power.
Level Of Evidence:
Level III, retrospective comparative case series.
