2023 ISAKOS Biennial Congress ePoster
Superior Capsule Reconstruction with Long Head of the Biceps Tendon for Massive Irreparable Rotator Cuff Tears
Marco Adriani, MD, Brescia, Brescia ITALY
Marcello Motta, MD, Brescia ITALY
Francesco DeFilippo, MD, Brescia ITALY
Alessandro Colosio, MD, Brescia ITALY
Maristella Francesca Saccomanno, MD, PhD, Brescia ITALY
Giuseppe Milano, Prof., Brescia, BS ITALY
University of Brescia, Brescia, ITALY
FDA Status Not Applicable
Summary
The use of the long head of the biceps tendon as autograft for superior capsule reconstruction has been proposed in several papers with different techniques, The aim of the present study was to evaluate the clinical outcome of arthroscopic superior capsular reconstruction with long head of the biceps tendon for the treatment of massive irreparable rotator cuff tears
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Abstract
Background
The use of the long head of the biceps tendon as autograft for superior capsule reconstruction has been proposed in several papers with different techniques. Recent biomechanical studies showed that it is biomechanically equivalent and potentially even stronger than fascia lata autograft in the prevention of superior humeral migration. The aim of the present study was to evaluate the clinical outcome of arthroscopic superior capsular reconstruction with long head of the biceps tendon for the treatment of massive irreparable rotator cuff tears. The hypothesis of the study was that superior capsular reconstruction with long head of the biceps tendon could improve subjective and functional outcomes.
Methods
A retrospective study was conducted. Patients with massive irreparable rotator cuff tears of the posterosuperior rotator cuff who underwent arthroscopic superior capsular reconstruction with autologous long head of the biceps tendon were included. Exclusion criteria were: shoulder stiffness, cuff-tear arthropathy, glenohumeral osteoarthritis, symptomatic acromioclavicular joint osteoarthritis, previous fractures and/or previous surgery to the same shoulder. Indication to superior capsular reconstruction was always confirmed arthroscopically after assessing cuff irreparability and testing the long head of the biceps tendon status. All patients underwent the same surgical technique and rehabilitation protocol. The long head of the biceps tendon was freed from its groove using an electrocautery device and then mobilized posteriorly. Two #2 high-strength non-absorbable braided sutures were passed about 5mm apart through the distal aspect of the intraarticular part of the tendon. The tendon was then released one centimeter distal to the most lateral suture and re-routed over the footprint of the posterior aspect of the supraspinatus tendon. The proximal stump of the long head of the biceps tendon was then fixed to the greater tuberosity using one knotless suture anchor. Partial repair of the infraspinatus with suture anchors was performed according to tear configuration and to tendon mobility and reducibility. Side-to-side repair between long head of the biceps and the infraspinatus tendon was also attempted. Primary outcome was the ASES score. Secondary outcomes were: QuickDASH and WORC score. A paired t-test was used to compare pre and postoperative outcomes. Significance was set at p < 0.05.
Results
The study included 12 males and 7 females. Mean age (+ SD) of patients was 61.74 ± 6.13 years. Mean follow-up was 26.61 ± 5.67. Comparison between pre- and postoperative functional scores showed significant clinical improvement (p < 0.001).
Conclusion
Arthroscopic superior capsular reconstruction with long head of the biceps tendon for the treatment of massive irreparable rotator cuff tears provides satisfactory subjective and functional outcomes.