Title : Partial superior capsular reconstruction with long head of the biceps tendon rerouting for the treatment of massive irreparable rotator cuff tears
Abstract:
Background: Massive Irreparable Rotator Cuff Tears (MIRCTs) remain challenging, with high failure rates after conventional repair. It is unclear which intervention may reduce the incidence of retears and improve outcomes.
Purpose: The purpose of this study was to evaluate the 2-year outcomes of partial Superior Capsular Reconstruction (pSCR) with Long Head of the Biceps Tendon (LHBT) rerouting combined with suture-bridge technique for the treatment of MIRCTs.
Method: We retrospectively studied 91 MIRCT patients who underwent arthroscopic pSCR with LHBT rerouting combined with suture-bridge technique between 2017 and 2021. After a minimum follow-up period of 2 years, postoperative clinical outcomes were compared using the American Shoulder and Elbow Surgeons (ASES); University of California, Los Angeles (UCLA); Constant; and Visual Analog Scale (VAS) for pain scores as well as the shoulder range of motion. The integrity of the tendons, the retear distance, and the acromiohumeral distance were evaluated through Magnetic Resonance Imaging (MRI) and X-ray.
Results: There was a significant improvement in all the clinical scores from the preoperative period to the final follow-up (P < 0.001) for VAS scores, ASES scores, UCLA scores, and Constant scores. The range of motion increased for forward flexion (115.92° to 170.38°), abduction (109.51° to 167.88°), and external rotation at 90° (51.85° to 57.39°) (both P<0.05). No significant improvement in internal rotation function was observed (P=0.991). The AHI increased from 5.55±2.40 mm to 9.31±2.29 mm (P<0.001). Among the 64 patients with postoperative MRI, 31.25% had retear. No cases of postoperative LHBT rupture or Popeye deformity occurred.
Conclusion: For MIRCTs, pSCR with LHBT rerouting combined with suture-bridge repair yielded significant pain relief, functional gains, and satisfactory structural outcomes without LHBT-related complications.
