Arthroscopic “Triple‐Beam” Biologic Augmentation of Massive Rotator Cuff Tears Using the Combined Long Head of Biceps Transposition and Autologous Palmaris Longus Tendon Bridging

Abstract The management of massive rotator cuff tears remains a substantial clinical challenge. Standard superior capsular reconstruction often fails to adequately restore the dynamic load‐transfer mechanics of the shoulder. Furthermore, direct repair of chronic, retracted tears is frequently associated with excessive tension, resulting in high rates of suture cut‐through and structural failure. To overcome these limitations, we describe an arthroscopic biological reconstruction technique termed the “Triple‐Beam” procedure. This approach combines transposition of the long head of the biceps tendon with augmentation using an autologous palmaris longus tendon bridge. The construct employs the transposed long head of the biceps tendon together with the anterior and posterior limbs of the palmaris longus graft to form a robust 3‐beam structure secured to the greater tuberosity. This design is intended to provide both static superior restraints to prevent superior humeral migration and dynamic load distribution, thereby reducing tension at the repair interface. As a cost‐effective, autologous strategy, this technique aims to improve biological healing and biomechanical stability in the management of massive rotator cuff tears.