Posterosuperior Massive Irreparable Rotator Cuff Tears: The Biceps Autograft

The treatment of massive rotator cuff tears remains challenging, since several irreversible factors like tendon retraction, muscle atrophy, fatty degeneration, and even ultrastructural changes of the muscle architecture predispose to high failure rates after direct repair. The superior capsular reconstruction by using either the fascia lata autograft or a dermal allograft patch is described in order to prevent superior humeral head migration and restore the anteroposterior shoulder muscle force couples. The purpose of this chapter is to describe a technical modification of the superior capsular reconstruction by using the long head biceps tendon autograft (LHBT). The tendon of the biceps is cut at the middle level of the bicipital groove and transferred and secured with anchors onto the footprint of the supraspinatus. Also, the tendon insertion on the glenoid with the surrounding labrum is left intact. This technique has theoretical biologic and biomechanical advantages and might be performed with the least technical demands, thus simplifying the original demanding procedure.