The Hosentraeger Technique: An Arthroscopic Tendon-in-Tendon Interposition Approach Using the Long Head of the Biceps for Irreparable Rotator Cuff Tears.

Abstract

Massive and irreparable rotator cuff tears (MIRCTs) represent a challenging clinical problem, particularly in younger patients in whom joint-preserving strategies are preferred. Although a range of surgical techniques exist-including partial repair, superior capsular reconstruction, and tendon transfer-none have shown clear superiority, and failure rates remain high. Autologous grafts such as long head of the biceps tendon (LHBT) grafts have gained attention because of their biological compatibility and accessibility. In this technical note, we present an arthroscopic tendon-in-tendon interposition technique-the "Hosentraeger technique"-that uses the LHBT to reconstruct the rotator cable in MIRCTs. After subpectoral tenodesis and glenoid tenotomy, the LHBT is passed through the remaining resistant portion of the rotator cuff and anchored laterally using knotless fixation. This technique aims to achieve stable biological integration by creating a direct tendon-to-tendon interface while restoring dynamic force transmission across the superior cuff. By avoiding the need for allografts or excessive tension on degenerated tendon remnants, this approach offers a reproducible, biologically favorable, and mechanically robust solution for MIRCTs in selected patients.