Table 1.

Step-by-step Surgical Procedures in Dynamic Biceps Rerouting for Irreparable Posterior-Superior Rotator Cuff Tear

1.Intra-articular debridement, subacromial debridement, and subacromial decompression are performed.

2.A switching stick is placed into the anterior subdeltoid space to elevate the anterior deltoid.

3.A far-lateral portal is created. Debridement is performed in the anterolateral subdeltoid space.

4.At the proximal edge of the insertion of the pectoralis major, the LHB that goes inferior to its insertion is found.

5.A far-anterior portal is created. Debridement in the anterior subdeltoid space and rotator interval release are performed.

6.The transverse humeral ligament is released to expose the LHB underneath.

7.The proximal aponeurosis of the pectoralis major is released by approximately 2 cm.

8.The LHB is ligated at the proximal edge of the pectoralis major with a PDS suture for later traction.

9.A new LHB groove is fabricated through the greater tuberosity.

10.The LHB is pulled out of the native LHB groove and located in the new LHB groove.

11.Another PDS suture is placed around the proximal part of the LHB.

12.The LHB is pulled posteriorly to expose the anterior edge of the new LHB groove.

13.Two double-loaded suture anchors are placed at the anterior edge of the new LHB groove.

14.Side-to-side rotator cuff repair is performed above the transferred LHB.

LHB, long head of biceps; PDS, polydioxanone.