Superior Capsular Reconstruction Technique for Massive Rotator Cuff Tear With Arthroscopic Transfer and Augmentation of Long Head of Biceps Brachii Tendon-The Biobridge Technique.

Abstract

Massive irreparable rotator cuff tears remain a major surgical challenge, often leading to pain, functional loss, and superior humeral migration. Superior capsular reconstruction has emerged as a technique to restore superior stability. Autologous augmentation using the long head of the biceps brachii tendon offers a cost-effective, biologically viable option, avoiding graft harvest and morbidity. We describe an all-arthroscopic technique of superior capsular reconstruction with long head of the biceps brachii tendon transposition and augmentation called Biobridge technique. The method involves careful tendon mobilization, release of the transverse humeral ligament, long head of the biceps brachii tendon fixation at the supraspinatus footprint, and reinforcement using a lasso-loop and shoelace configuration, completed with a double-row repair. This construct provides superior restraint and improved footprint coverage while maintaining vascularized autologous tissue. Biomechanical and clinical studies suggest this technique improves pain, motion, and acromiohumeral distance while lowering retear risk in appropriately selected patients. This article describes the step-by-step surgical approach, indications, and rationale for the Biobridge technique, highlighting its potential as a reproducible and biologically sound alternative to graft-based reconstructions.