Reinforcing Anterosuperior Medium‐to‐Large Rotator Cuff Repairs With the Long Head of the Biceps Tendon and Dermal Allograft Patch Using a Knotless Double‐Row Technique

We describe a surgical technique repairing medium‐to‐large anterosuperior rotator cuff (RC) tear that combines long head of the biceps tendon (LHBT) augmentation with a dermal allograft patch using a knotless double‐row repair. LHBT augmentation is done using a triple‐loaded anchor placed 5 mm posterior to the bicipital groove at the bone‐cartilage junction. One suture strand creates a lasso‐loop, rip‐stop configuration to secure and posteriorly reroute the LHBT, improving anterior cable coverage. The remaining medial anchor sutures function as mattress sutures through the supraspinatus. Knots are tied, but the suture limbs are left uncut to secure the graft later to the cuff. A 3 × 3 cm, 2 × 2 mm thick dermal allograft is prepared. The uncut medial row sutures and a nonabsorbable tape suture (for lateral fixation) are passed through the graft. Using a custom cannula and traction sutures placed on the corners, the graft is shuttled and positioned on the bursal side of the repaired tendon. Once positioned, the medial sutures are secured. All remaining sutures (medial limbs, nonabsorbable tape suture, and traction sutures) are loaded into a lateral row anchor and impacted into the greater tuberosity. The final construct sandwiches the repaired tendon beneath the allograft, increasing construct thickness and ensuring complete footprint coverage.