Segmented Double-Unit Bridging Technique Using Autologous Semitendinosus Graft for Massive Irreparable Rotator Cuff Tears.

Massive irreparable rotator cuff tears remain a surgical challenge. Whereas the subscapularis and infraspinatus can often be repaired anatomically, the supraspinatus frequently presents an irreparable defect. Current options such as superior capsular reconstruction provide only static, compensatory solutions. This article describes a segmented double-unit bridging technique using an autologous semitendinosus tendon for anatomical and dynamic reconstruction. The harvested tendon is divided into 2 independent segments, each folded to form a robust graft unit. These 2 units are sequentially implanted: the first bridges the anterior portion of the supraspinatus defect, followed by the second for the posterior portion. This double-unit, segmented bridging technique simplifies graft handling and suture management compared with single-graft techniques and enables stable, anatomical repair. It offers a practical surgical solution for restoring shoulder biomechanics in massive irreparable rotator cuff tears.