Biceps-based 3-layer reconstruction of the irreparable rotator cuff: a technical note on biceps tendon as a common local graft for in-situ superior capsular reconstruction, partial cuff repair, and middle trapezius tendon transfer

BACKGROUND: For irreparable rotator cuff tears, 3-layer tendon reconstruction (in which in-situ superior capsular reconstruction-reinforced partial rotator cuff repair was augmented with hamstring-sheet-lengthened middle trapezius tendon transfer) was recently reported to achieve satisfactory postoperative outcomes. To avoid hamstring graft-related drawbacks, the current note describes a technical modification of that reconstruct; wherein long head of biceps tendon is used as a cornerstone structure for simultaneously reconstructing the superior capsule; lengthening the transferred middle trapezius tendon; and augmenting the partially-repaired rotator cuff. METHODS: Via sub-pectoral approach, long head of biceps tendon is distally-tenotomized. Through McKenzie approach, proximal stump of the tenotomized long head of biceps is retrieved to the sub-acromial space where double-row biceps tenodesis (into a trough at the greater tuberosity) is performed for reconstructing the superior capsule. Next, postero-superior rotator cuff is partially repaired, and side-to-side sutured to the reconstructed capsule. Through a 7–8-cm skin incision over the medial scapular spine, middle trapezius tendon is released. Portion of long head of biceps tendon distal to the tenodesis site is retrieved via a sub-trapezius/sub-acromial corridor to the scapular wound where it is re-attached to the released middle trapezius tendon. RESULTS: Use of long head of biceps tendon as a common local graft (for simultaneously reconstructing the superior capsule, lengthening the transferred middle trapezius tendon, and augmenting the partially-repaired rotator cuff) is technically feasible provided that the harvested tendon stump is at least 10 cm in length. CONCLUSION: While avoiding hamstring graft-related complications, the currently-reported biceps-based 3-layer rotator cuff tendon reconstruction might offer the advantages of reproducibility, safety, simplicity and quickness; however, it should be validated via further studies. Trial registration The present study was approved by the Institutional Committee of Scientific Research and Ethics (3-2023Orth10-1). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13018-023-03978-0.