Thanks, and while our next speaker, Dr. Giuseppe Milano, comes up to talk about bio-SCR with biceps, I want to ask Dr. Mahata, over 10 years of doing this well, how have you changed? Has your technique evolved? Have you changed some things in your technique? Yeah, great. Thank you very much. Actually, when I studied the surgery, actually, the very complicated techniques, so now I try to make this surgery easier. Yeah, so now, actually, I think that getting much better is easy surgery, so now even in young doctors in Japan, they can do these surgeries if they learn. Thank you. So, Dr. Milano, please come up. And he'll again be talking about bio-SCR using the biceps, and he's going to present a video technique here for seven minutes. Thank you. Good afternoon, everybody. It's a great honor for me to present to you today. I really appreciate. So, my talk is about an alternative technique for superior capsule reconstruction. This is my disclosure. As reported in the literature, superior capsule reconstruction can be accomplished with different grafts. Fascia latae, for sure, is the most popular, together with the extracellular dermal matrix, but also the long head or the biceps tendon is increasing in popularity during the last years. The rationale of this technique is to recreate static restraints against the superior migration of the human head by recreating the anterior cable of the rotator cuff, according to this biomechanical study. And there are some advantages in the use of this graft, because donor-side morbidity is absent. The technique is very cheap, it's very fast, and it's easy to manage during arthroscopy, because you can decide just during your procedure. And many biomechanical studies confirmed that the strength of the graft is adequate, comparable to the fascia latae or extracellular dermal matrix. Several clinical reports exist in the literature that show the satisfactory preliminary results with the use of this technique to address irreparable rotator cuff tears. So, this is a standard technique, it's pretty easy. You just cut the biceps, so you make a tenotomy at the extraticular exit of the tendon. I pass first a couple of sutures by tendon loop configuration, and then I make my tenotomy distal to my sutures, and the tendon is rerouted over the footprint of the supraspinatus to recreate the passive restraints. Then you can repair, you can make a partial repair of the posterior cuff. And these are my preliminary results, this is my first serious two-year follow-up, and as you can see, we have a very significant improvement in patient-reported outcomes. But the biceps can be also used as augmentation for repair of massive rotator cuff tears, specifically with the delamination of the posterior side, where the chance for healing is pretty low. And this is a biologic and mechanical augmentation at the same time. So, this is the technique that we define, the cuff plus. So, substantially, we make the same technique of biceps tenodesis over the footprint of the supraspinatus. But in this case, the rotator cuff is repairable, but the risk of re-tear is pretty high. So, the biceps is fixed first on the footprint of the supraspinatus, and then the rotator cuff is repaired over, and it potentially increases the chance for healing, because it repairs the cuff against the strain due to the superior migration to the humeral head. These are, again, results of our first case series, a two-year follow-up, more than two-year follow-up, and patient-reported outcomes have significantly improved. But this study, recently published in the American Journal of Sports Medicine, confirmed that the use of biceps to augment the massive rotator cuff repair has a marked reduction of re-tear rate. So, what to do when the biceps is missing because of a previous rupture or in case of revision surgery? I use the semitendinosus. We described first this technique arthroscopically. The semitendinosus is doubled and fixed on the glenoid, on the two-point fixation, anterior and posterior, and fixed in a box-shaped configuration. Then other two fixation points are achieved on the humerus, and the result is quite similar. So, we have a double strand, a double cable, anterior and posterior, and this is specifically for irreparable rotator cuff tears. Thank you very much.

surgical technique

evolution

bio-SCR

biceps

patient-reported outcomes