Arthroscopic Anatomic Rotator Cable Reconstruction Using Palmaris Longus Autograft: Surgical Technique

This technical note describes an arthroscopic anatomic rotator cable reconstruction technique using a palmaris longus tendon autograft for selected large U‐shaped posterosuperior rotator cuff tears with limited tendon mobility. After thorough stepwise release and mobilization, the graft is introduced into the subacromial space and fixed to the anatomic anterior and posterior cable insertion sites and woven through the residual rotator cuff near the musculotendinous junction. The graft is tensioned to recreate the native semilunar cable arc, whereas the rotator cuff is simultaneously reduced to the medial footprint, followed by combined cuff‐to‐bone repair over the reconstructed cable. By recreating the native anterior‐posterior cable architecture and integrating the autologous graft with the repaired cuff, this technique aims to restore biomechanical load‐sharing and force coupling while permitting long‐term biologic incorporation. As such, arthroscopic rotator cable reconstruction using a palmaris longus autograft may provide a valuable anatomic surgical option for rotator cable‐deficient shoulders in which anatomic tendon repair alone is not feasible.