A Biologic Hybrid Approach Combining Superior Capsular Reconstruction, Long Head of the Biceps Tendon Rerouting, and Rotator Cuff Repair

Large to massive posterior superior rotator cuff tears remain challenging to treat because chronic tendon retraction, fatty degeneration, and muscle atrophy often preclude durable repair. Superior capsular reconstruction using fascia lata autograft has been introduced to restore superior glenohumeral stability; however, graft failure, donor site morbidity, and limited biological incorporation remain concerns. Use of the long head of the biceps tendon (LHBT) as an autologous, vascularized tissue source has been proposed to enhance biological healing and avoid allograft-related complications, although isolated LHBT-based techniques may provide limited and unpredictable stability. This technical note describes a hybrid arthroscopic technique that combines standard superior capsular reconstruction with LHBT rerouting and augmentation using available rotator cuff tissue. The procedure integrates 3 complementary components: rerouting and fixation of the LHBT as a biologic static stabilizer, dermal allograft-based superior capsular reconstruction to restore superior capsular integrity, and triple-row augmentation of remnant rotator cuff tissue over the construct to maximize footprint coverage and biological healing potential. Indications include large to massive posterior superior rotator cuff tears with an intact or minimally torn LHBT and without advanced glenohumeral arthritis. This combined approach aims to improve superior glenohumeral stability, enhance graft support, and create a favorable biological environment while maintaining a reproducible arthroscopic workflow.