Margin convergence of the posterior rotator cuff to the biceps tendon.

Massive rotator cuff tears can often be repaired arthroscopically with satisfactory results. Tear pattern recognition, knot security, and loop security are essential in the repair of large and massive rotator cuff tears. In the case of a massive U-shaped tear, with a contracted immobile supraspinatus and a deficient rotator interval, a type of margin convergence technique can be used. This technique allows for the partial closure of the rotator cuff defect along with the proximal advancement of the posterior cuff by securing the posterior leaf of the cuff tendon to the tendon of the long head of the biceps brachii. Because of the mechanical effect of strain reduction in margin convergence, this procedure decreases the strain at the margin of the posterior cuff, thereby protecting its repair to bone. Our goal with this procedure is not to obtain healing of the cuff to the biceps, but to optimize the conditions for healing of the rotator cuff to bone.