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

Modified longhead of biceps tendon rerouting and fixation as a partial capsular reconstruction for massive irrepairable rotator cuff tears. The procedure demonstrated in this video adhered to the guidelines established by the Ethics Committee of West China Hospital, including regulations on research activity. Examination of the glenohumeral joint and the subacromial space.

The comma sign represents the full thickness of superior subscapularis tear. Arthroscopy revealed a massive repairable rotator cuff tear with significant tendon retraction. The integrity of the biceps were also assessed.

With the tendon grasper, an evolution of rotator cuff retraction was also performed. Intraarticular and the subacromial debridement and rotator cuff release. Advance the arthroscope into the subacromial space through the posterior portal.

Examine the subacromial space to evaluate any associated pathology. Use the shaver to debride the hypertrophic tissue and soft tissue at the anterolateral subacromial region through the anterolateral portal. Perform acromioplasty using burr to safely recontour the acromion.

Remove the osteophytes and freshen the points on the greater tuberosity. Begin rotator cuff release with anterior tissues including the coracohumeral ligaments. Use the radio frequency electrocautery device to release the coracohumeral ligaments.

Remove any inflammatory or hypertrophic tissues. This effectively created adequate space between the coracoid and the subscapularis tendon. Perform coracoplasty after the release of the coracohumeral ligament if the distance between the coracoid and the subscapularis tendon is less than five millimeters.

Release joint capsule and perform double-sided release of the rotator cuff on both the bursal and articular surfaces. Carefully separate the regions between the infraspinatus and the supraspinatus. Fabricating new LHBT groove and rerouting LHBT.

Before creating the new bicep growth, position the arthroscope through the lateral portal. Introduce the radio frequency wand and shaver through the anterolateral portal. Release the transverse humeral ligament to expose LHBT beneath it.

Release the proximal aponeurosis of the pectoralis major by approximately 5 centimeters to facilitate posterolateral transfer of the LHBT. Create longitudinal groove in the middle of the greater tuberosity which adequate depth and width to accommodate the enlarged LHBT. Extend the groove from the cartilage edge of the humeral head through the greater tuberosity to a point approximately one to 1.5 centimeters distal to the tip of the greater tuberosity.

There were 18 tear at the distal end. Insert the anchor as the most proximal part of the new LHBT groove. Introduce a suture hook preloaded with suture through the anterior portal.

Pass the tip of the hook through the body of the LHBT to form a lasso loop around the tendon at the anchor site. Pass the end of the suture that created the loop through the loop to calculate the lasso loop. At the outside part of the suture using an SMC knot followed by an additional knot to secure the LHBT.

Place one knot anteriorly and the other posteriorly. Leave all suture uncut. Rotator cuff repair.

Place an additional anchor in the posterolateral aspect of the greater tuberosity just posterior to the LHBT to repair a posterior rotator cuff tear. Place a anchor on the lesser tuberosity to repair the subscapularis tendon as classified as type 3 or higher. Use the sutures from the previously inserted anchors securing the LHBT to assist rotator cuff repair.

Perform a side to side marginal repair over the LHBT. Use the suture bridge technique to repair the rotator cuff. Insert two anchors in the anterior and the posterior regions.

Close the structures over the top of the new bicipital groove to formally comprise the lateral edge of the rotator cuff and the rotated LHBT within the groove. Representative results. A follow up MRI at six months and two years postoperatively indicated restoration of tendon continuity and a secure anchor fixation signify a successful surgical outcome.

Postoperatively, all symptoms were alleviated or resolved.