Superior capsular reconstruction of the shoulder: the ABC (Arthroscopic Biceps Chillemi) technique


Superior capsular reconstruction (SCR) demonstrated its efficacy as a treatment option available in patients affected with irreparable posterosuperior rotator cuff tears without any signs of arthritis. Originally, the fascia lata autograft was fixed medially to the glenoid (with two or more anchors) and laterally to the greater tuberosity (with a compression double-row technique using four anchors or three transosseous tunnels). Additionally, side-to-side sutures were used to anteriorly and posteriorly connect the graft to the native residual rotator cuff tissue. However, the fascia lata as an autograft has a disadvantage related to the donor-site morbidity. To solve this aspect, allografts were employed with initial promising results. Nowadays, SCR is to be considered a technically demanding and expensive procedure, because of the cost of the allograft plus that of all the anchors employed to fix it. The Arthroscopic Biceps Chillemi’s technique addresses these concerns in performing SCR and presents numerous advantages being a safe, easier, time and cost-saving way compared to the other published techniques. This technique has only one conditio sine qua non: the presence of the long head of the biceps tendon (LHB), used as an autograft. This condition may be interpreted as a disadvantage of this procedure in the presence of some anatomic variations of the intra-articular portion of the LHB and the very rare absence of the tendon or in case of partial or complete rupture of the LHB tendon associated with a rotator cuff tear.

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  1. 1.

    Adams CR, Denard PJ, Brady PC, Hartzler RU, Burkhart SS (2016) The arthroscopic superior capsular reconstruction. Am J Orthop 45(5):320–324

    PubMed  Google Scholar 

  2. 2.

    Chillemi C, Petrozza V, Garro L, Sardella B, Diotallevi R, Ferrara A, Gigante A, Di Cristofano C, Castagna A, Della Rocca C (2011) Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors. Knee Surg Sports Traumatol Arthrosc 19(9):1588–1596

    Article  PubMed  CAS  Google Scholar 

  3. 3.

    Narvani AA, Imam MA, Polyzois I, Sarkhel T, Gupta R, Levy O, Consigliere P (2017) The “Pull-Over” technique for all arthroscopic rotator cuff repair with extracellular matrix augmentation. Arthrosc Tech 6(3):e679–e687

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Burkhart SS, Denard PJ, Adams CR, Brady PC, Hartzler RU (2016) Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff repair. Arthrosc Tech 5(6):1407–1418

    Article  Google Scholar 

  5. 5.

    de Cupis V, Chillemi C, Marinelli M (2008) Grammont inverted prosthesis for the treatment of cuff tear arthropathy: a 6-year follow-up study. Orthopedics 31(5):447–452

    Article  PubMed  Google Scholar 

  6. 6.

    Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A (1994) Partial repair of irreparable rotator cuff tears. Arthroscopy 10:363–370

    Article  PubMed  CAS  Google Scholar 

  7. 7.

    Merolla G, Chillemi C, Franceschini V, Cerciello S, Ippolito G, Paladini P, Porcellini G (2015) Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale. Muscles Ligaments Tendons J 4(4):425–432

    PubMed  PubMed Central  Google Scholar 

  8. 8.

    Mihata T, Watanabe C, Fukunishi K, Tsujimura T, Ohue M, Kinoshita M (2010) Clinical outcomes after arthroscopic superior capsular reconstruction for irreparable rotator cuff tear. Shoulder Joint 34:451–453

    Google Scholar 

  9. 9.

    Schwartz E, Warren RF, O’Brien SJ, Fronek J (1987) Posterior shoulder instability. Orthop Clin North Am 18:409–419

    PubMed  CAS  Google Scholar 

  10. 10.

    Neer CS 2nd, Craig EV, Fukuda H (1983) Cuff-tear arthropathy. J Bone Joint Surg Am 65:1232–1244

    Article  PubMed  Google Scholar 

  11. 11.

    Boileau P, McClelland WB Jr, Rumian AP (2014) Massive irreparable rotator cuff tears: how to rebalance the cuff-deficient shoulder. Instr Course Lect 63:71–83

    PubMed  Google Scholar 

  12. 12.

    Paxton ES, Dodson CC, Lazarus MD (2014) Shoulder instability in older patients. Orthop Clin North Am 45:377–385

    Article  PubMed  Google Scholar 

  13. 13.

    Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ (2012) Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med 40:2248–2255

    Article  PubMed  Google Scholar 

  14. 14.

    Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ (2016) Biomechanical role of capsular continuity in superior capsule reconstruction for irreparable tears of the supraspinatus tendon. Am J Sports Med 44(6):1423–1430

    Article  PubMed  Google Scholar 

  15. 15.

    Limpisvasti O, Yang BY, Hosseinzadeh P, Leba TB, Tibone JE, Lee TQ (2008) The effect of glenohumeral position on the shoulder after traumatic anterior dislocation. Am J Sports Med 36:775–780

    Article  PubMed  Google Scholar 

  16. 16.

    Burkhart SS, Ricchetti ET, Levine WN, Galatz LM (2016) Challenges and controversies in treating massive rotator cuff tears. Instr Course Lect 65:93–108

    PubMed  Google Scholar 

  17. 17.

    Boutsiadis A, Chen S, Jiang C, Lenoir H, Delsol P, Barth J (2017) Long head of the biceps as a suitable available local tissue autograft for superior capsular reconstruction: “The Chinese Way”. Arthrosc Tech 6(5):e1559–e1566

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89(6):1184–1193

    Article  PubMed  Google Scholar 

  19. 19.

    Zumstein MA, Raniga S, Labrinidis A, Eng K, Bain GI, Moor BK (2016) Optimal lateral row anchor positioning in posterior-superior transosseous equivalent rotator cuff repair: a micro-computed tomography study. Orthop J Sports Med 4(11):1–7

    Article  Google Scholar 

  20. 20.

    Chillemi C, Mantovani M, Osimani M, Castagna A (2017) Arthroscopic transosseous rotator cuff repair: the eight-shape technique. Eur J Orthop Surg Traumatol 27(3):399–404

    Article  PubMed  Google Scholar 

  21. 21.

    Petri M, Greenspoon JA, Millett PJ (2015) Arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthrosc Tech 4(6):e751-5

    Article  PubMed  Google Scholar 

  22. 22.

    Hirahara AM, Adams CR (2015) Arthroscopic superior capsular reconstruction for treatment of massive irreparable rotator cuff tears. Arthrosc Tech 4(6):e637-41

    Article  PubMed  Google Scholar 

  23. 23.

    Adams CR, DeMartino AM, Rego G, Denard PJ, Burkhart SS (2016) The rotator cuff and the superior capsule: why we need both. Arthroscopy 32(12):2628–2637

    Article  PubMed  Google Scholar 

  24. 24.

    Hartzler RU, Burkhart SS (2017) Superior capsular reconstruction. Orthopedics 40(5):271–280

    Article  PubMed  Google Scholar 

  25. 25.

    Mihata T, Bui CNH, Akeda M, Cavagnaro MA, Kuenzler M, Peterson AB, McGarry MH, Itami Y, Limpisvasti O, Neo M, Lee TQ (2017) A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear. J Shoulder Elbow Surg 26(12):2158–2166

    Article  PubMed  Google Scholar 

  26. 26.

    Sutter EG, Godin JA, Garrigues GE (2017) All-arthroscopic superior shoulder capsule reconstruction with partial rotator cuff repair. Orthopedics 40(4):735–738

    Article  Google Scholar 

  27. 27.

    Hirahara AM, Andersen WJ, Panero AJ (2017) Superior capsular reconstruction: clinical outcomes after minimum 2-year follow-up. Am J Orthop 46:6

    Google Scholar 

  28. 28.

    Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, Kinoshita M (2013) Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy 29(3):459–470

    Article  PubMed  Google Scholar 

  29. 29.

    Dierickx C, Ceccarelli E, Conti M, Vanlommel J, Castagna A (2009) Variations of the intra-articular portion of the long head of the biceps tendon: a classification of embryologically explained variations. J Shoulder Elbow Surg 18(4):556–565

    Article  PubMed  Google Scholar 

  30. 30.

    Chen CH, Chen CH, Chang CH, Su CI, Wang KC, Wang IC, Liu HT, Yu CM, Hsu KY (2012) Classification and analysis of pathology of the long head of the biceps tendon in complete rotator cuff tears. Chang Gung Med J 35(3):263–270

    PubMed  Google Scholar 

  31. 31.

    Chillemi C, Petrozza V, Franceschini V, Garro L, Pacchiarotti A, Porta N, Cirenza M, Salate Santone F, Castagna A (2016) The role of tendon and subacromial bursa in rotator cuff tear pain: a clinical and histopathological study. Knee Surg Sports Traumatol Arthrosc 24(12):3779–3786

    Article  PubMed  Google Scholar 

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A special thanks to Miss Ilaria Bondi, medical graphic designer (, for preparing all the illustrations of this paper.

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Corresponding author

Correspondence to Claudio Chillemi.

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Conflict of interest

Claudio Chillemi declares that he has no conflict of interest. Matteo Mantovani designed and manufactured the Taylor Stitcher Evo® + Superelastic Transosseous Needle®. Antonio Gigante declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Chillemi, C., Mantovani, M. & Gigante, A. Superior capsular reconstruction of the shoulder: the ABC (Arthroscopic Biceps Chillemi) technique. Eur J Orthop Surg Traumatol 28, 1215–1223 (2018).

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  • Rotator cuff
  • Irreparable
  • Tear
  • LHB tendon
  • Superior capsular reconstruction