Rotator cuff tears with anterior cable disruption demonstrate more progressive deterioration compared to tears where this area remains intact. Reconstruction of the rotator cuff anterior cable (RCAC) during rotator cuff repair may be an avenue to improve outcomes in this patient population.
A retrospective case series was performed on patients with repairable large-to-massive rotator cuff tears with anterior cable disruption and poor anterior cable tissue quality who underwent arthroscopic rotator cuff repair with RCAC reconstruction utilizing LHB tendon autograft. PROMIS Pain Interference (PI), PROMIS Physical Function (PF), PROMIS Depression (D), and pain VAS, as well as clinical shoulder range of motion measurements were reviewed postoperatively at 1-year and compared to preoperative findings.
Surgical Technique: After mobilization of retracted rotator cuff tissue to, arthroscopic biceps tenodesis was performed in the superior bicipital groove. With the biceps tendon still attached to the glenoid a free suture is placed in the LHB tendon using a pants-over-vest technique near the origin of the LHB and then also passed more medially through the anteromedial margin of the supraspinatus tendon (site of anterior rotator cable). The proximal biceps origin is now released and the free suture limbs are tied, advancing the rotator cuff tissue along the LHB. This process can be repeated with 1-2 free sutures to further advance the rotator cuff laterally, with the LHB serving as a scaffold. Once RCAC reconstruction is completed, a standard transosseous equivalent technique is used to achieve rotator cuff repair of the remaining tendon tissue.
23 patients met inclusion criteria for this study. At 1-year follow up, PROMIS PI T-scores improved by a mean of 10.3 (p<0.01), PF improved by 7.0 (p<0.01), and D improved by 5.0 (p=0.02). VAS pain scores improved by a mean of 5.0 cm (p<0.01). Patients gained a mean of 31 degrees of active forward flexion (p<0.01) and 11 degrees of active external rotation (p=0.02). 2 patients experienced retears of their rotator cuff repairs and both required reverse total shoulder arthroplasty.
The proposed RCAC reconstruction technique utilizing LHB autograft for large and massive repairable rotator cuff tears involving the anterior cable provides a potential avenue to improve tissue quality of the repaired construct, with short term outcomes showing significant clinical improvements.