Biceps Smash Technique: Biceps Tendon Autograft Augmentation for Arthroscopic Rotator Cuff Reconstruction

Anterior Labral Reconstruction With Biceps Autograft for Anterior Shoulder Instability

Shoulder instability is a common problem, with current research focused on understanding the implications of humeral and glenoid bone loss. Soft tissue injury, including damage to the anterior labrum, deformity of the capsule, and disruption of the inferior glenohumeral ligament, also contributes to the pathology of shoulder dislocation with implications for recurrent instability. Anatomic placement of the labral tissue and restoration of capsular tension are essential components of successful arthroscopic Bankart repair (ABR). Patients who meet criteria for ABR with a diminutive, ruptured, or absent anterior labrum at the time of arthroscopic stabilization present a significant challenge to repair. In this Technical Note, we demonstrate a technique using biceps autograft to reconstruct the anterior labrum.

Editorial Commentary: Shoulder Long Head of the Biceps Tendon Transposition Without Tenotomy May Be a Beneficial Augment for Massive Rotator Cuff Tear Repair

Although many surgeons discard the long head of the biceps (LHB) tendon during arthroscopic rotator cuff repairs, several authors have argued that the LHB tendon may serve as a biologic and structural augment for massive repairs. There are multiple benefits of incorporating the LHB tendon autograft in difficult-to-repair massive rotator cuff tears. First, by maintaining the glenoid origin, the tendon likely retains a significant native blood supply, as well as tenocytes, which may support the healing process. In addition, there are several biomechanical benefits. The LHB may act as a dynamic humeral head depressor since it is still attached to the muscular unit distally. The tendon could also serve as a convergence post, while proving robust tissue for the repair. Also, the LHB tendon may decrease undue tension on the repair, bringing us closer to a tension-free repair. Finally, this may be a cost-conscious technique. One concern, requiring additional investigation, is that some surgeons believe the LHB may be a pain generator in patients with rotator cuff tears. One surgeon's trash is another surgeon's treasure.