Table 2.

Pearls and Pitfalls of Dynamic Biceps Rerouting for Irreparable Posterior-Superior Rotator Cuff Tear

Using the Posterior or Anterior Leaf of the rotator Cuff to Cover the Bicipital Groove Depends on the Movability of the 2 Leaves. When the Movability of the Anterior Leaf is Greater, the Suture Anchors are Placed at the Posterior Edge of the new LHB Groove to Bring the Anterior Leaf over the new Groove.

Dynamic rerouting is mainly indicated for U- or V-shaped large or massive rotator cuff tears but is also indicated for other kinds of rotator cuff tears when a groove cover can be created. It is unsuitable for rotator cuff tears in which a groove cover cannot be created, in which condition static biceps rerouting may be more suitable.

The superior part of the aponeurosis of the pectoralis major should be released. Otherwise, posterior transfer of the LHB may be hindered.

The size of the groove should be slightly larger than the size of the LHB. Otherwise, micromotion of the LHB within the groove may be hindered.

When a remnant rotator cuff connection between the native and new LHB grooves exists, this part of the rotator cuff is detached with a thin layer of cortical bone to allow posterior transfer of the LHB. The detached rotator cuff is subsequently reattached by side-to-side rotator cuff repair.

In case of a combined SLAP lesion, SLAP repair is first performed, before LHB transfer.

LHB, long head of biceps.