Superior Capsular Reconstruction With a Long Head of the Biceps Tendon Autograft: A Cadaveric Study

Background: Several procedures have been proposed to address irreparable rotator cuff (RC) tears with pseudoparalysis. One recently proposed procedure is superior capsular reconstruction (SCR) using a tensor fasciae latae (TFL) autograft. Hypothesis: SCR with a locally available long head of the biceps tendon (LHB) autograft is biomechanically equivalent to SCR using TFL autograft for preventing superior humeral migration and the development of RC arthropathy in patients with irreparable RC tears. Study Design: Controlled laboratory study. Methods: Ten cadaveric shoulders (5 matched pairs) were tested. One shoulder from each pair was randomly assigned to the LHB reconstruction group using our novel technique, while the contralateral side was assigned to the TFL reconstruction group. SCR with a TFL autograft was performed based on previously described techniques. Massive RC tears were created by detachment of the supraspinatus and infraspinatus footprints from the greater tuberosity. The force required to superiorly translate the humerus 1.5 cm was then tested and recorded using a servohydraulic testing machine under 2 conditions: (1) after a massive RC tear and (2) after SCR with either a TFL autograft or an LHB autograft. Results: SCR with an LHB autograft required 393.2% 87.9% (P = .029) of the force needed for superior humeral migration in the massive RC tear condition, while SCR with a TFL autograft required 194.0% 21.8% (P = .0125). The LHB reconstruction group trended toward a stronger reconstruction when normalized to the torn condition (P = .059). Conclusion: SCR with an LHB autograft is a feasible procedure that is shown to be biomechanically equivalent and potentially even stronger than SCR with a TFL autograft in the prevention of superior humeral migration. Clinical Relevance: This new technique may help to prevent superior humeral migration and the development of RC arthropathy in patients with irreparable RC tears.