Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft

Massive irreparable rotator cuff tears (MIRCTs) are not uncommon in clinical practice, significantly impacting shoulder function and daily activities. Extensive tear size, tendon contracture, and fat infiltration within the rotator cuff pose significant challenges for both patients and clinicians. This type of tear is a key area of interest and a challenge in research and treatments. Current treatment options include conservative management, debridement, partial repair, superior capsule reconstruction (SCR), tendon transfers, and reverse total shoulder arthroplasty (RTSA). However, clinical outcomes vary widely. The rotator cable (RC) exhibits a perpendicular orientation with respect to the superior rotator cuffs, thereby forming an arc-shaped attachment to the proximal humerus, and it plays an essential role in maintaining the rotator cuff's force couple. The attachments of both anterior and posterior RC play a crucial role in facilitating overhead movements. When complete tension-free coverage of the footprint cannot be attained, whole rotator cable reconstruction (WRCR) presents as an alternative approach for MIRCTs. We utilized autologous tendon harvested from the proximal biceps tendon for arthroscopic WRCR. The proposed technique offers distinct advantages: autologous tissue utilization eliminates immunogenicity; simplified harvesting reduces operative complexity; and minimized anchor usage enhances cost-effectiveness. In this study, 12 patients underwent WRCR, with significant improvements in shoulder function and pain relief observed during a 1 year follow-up.