Rotator Cuff Anterior Cable Reconstruction With Long Head of Biceps Tendon Autograft

Figures

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  Figure 1. Arthroscopic view of the left shoulder from the lateral portal, beach chair position. A massive rotator cuff tear with disruption of the anterior cable is seen. The long head of the biceps (LHB) tendon is intact, and the torn tendon has been mobilized to be able to reach the medial edge of the greater tuberosity (GT) without undue tension. SS, supraspinatus.

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  Figure 2. Arthroscopic view of the left shoulder from the lateral portal, beach chair position. Biceps tenodesis at the superior bicipital groove has been performed with incorporation of anterior rotator interval tissue. The long head of the biceps (LHB) tendon remains attached to the supraglenoid tubercle.

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  Figure 3. Arthroscopic view of the left shoulder from the lateral portal, beach chair position. (A) Both limbs of a free suture are passed through the long head of the biceps (LHB) tendon near its origin and then through the anterior cable tissue in a “pants-over-vest” fashion. (B) Before knot tying, the LHB origin is released. (C) The suture limbs are then arthroscopically tied. (D) Two more free sutures are placed using a similar technique, advancing the anterior supraspinatus (SS) tissue laterally along the LHB tendon. This completes the anterior cable reconstruction. RI, rotator interval tissue.

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  Figure 4. Arthroscopic view of the left shoulder from the lateral portal, beach chair position. Completed rotator cuff transosseous equivalent repair with anterior cable reconstruction (ACR) using long head of the biceps (LHB) autograft. SS, supraspinatus.

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  Figure 5. Schematic drawings of anterior cable reconstruction using long head of the biceps (LHB) autograft. Depicted is a left shoulder. (A) A large rotator cuff tear involving the supraspinatus and infraspinatus. An arthroscopic biceps tenodesis is then performed (not pictured). (B) Near the origin of the long head of the biceps tendon, both limbs of a free suture are passed through the biceps tendon. In a “pants-over-vest” fashion, the suture limbs are then passed through the anteromedial margin of the supraspinatus tendon (site of the anterior cable). (C and D) The proximal long head of biceps origin is then released, and the suture limbs are tied arthroscopically, advancing the cuff tissue along the scaffold provided by the LHB tendon. (E) Another free suture is then passed in a similar fashion at a location more distal on the LHB tendon. (F) As this second suture is tied down, the anterior rotator cuff tissue is advanced further distally along the LHB tendon. (G) This process can be again repeated, marching the remainder of the anterior rotator cuff tissue along the LHB tendon, toward the greater tuberosity.