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

Massive irreparable rotator cuff tears (MIRCTs) present a particularly complex and difficult challenge for the orthopedic surgeon. Fatty infiltration of muscles, chronic excessive retraction of tendons, and overall tissue degeneration predispose these cases to high failure rates following surgical treatment. Several approaches have been introduced for transferring the long head of the biceps tendon (LHBT) to help stabilize the humeral head and reestablish shoulder muscle strength. This article proposes a technical modification of capsular reconstruction using arthroscopic LHBT rerouting and fixation, which can enhance the repair of MIRCTs. The essential steps of this procedure involve exposing the native bicipital groove following full release of the rotator cuff, forming a new groove in the greater tuberosity, redirecting the LHBT into this newly created channel with secure fixation, and completing a side-to-side rotator cuff repair over the tendon, making the method suitable for most patients. Our clinical experience suggests this technique can be safely implemented following specific guidelines. We believe that the introduction of this technique offers new insights into reducing sharp graft angulation ("killer turn"), such as the sharp angulation seen in modified "Chinese Way" techniques, where the graft is positioned in the bicipital groove, thereby reducing graft wear caused by this acute angulation. This modification reduces graft wear caused by this acute angulation and provides better humeral head-depression effects. Additionally, the newly created groove facilitates healing between the LHBT and the greater tuberosity, lowering the risk of retear after rotator cuff repair.