Massive and irreparable rotator cuff tear treatment by arthroscopic partial repair with long head of the biceps tendon augmentation provides better healing and functional results than partial repair only

Abstract

The aim of this study was to compare clinical and radiological outcomes of two treatment methods of massive and irreparable rotator cuff tears: partial repair (PR) and PR with long head of the biceps tendon augmentation (PRLHBTA). Biceps tendon augmentation is believed to promote better healing at the bone-tendon junction, leading clinical and radiological outcomes. This retrospective and comparative study included patients with chronic, massive and irreparable rotator cuff tears involving both the supraspinatus (SSP) and infraspinatus (ISP) muscles. Only patients who had previously failed non-operative treatment and had at least 1-year follow-up between 2013 and 2018 were analyzed. The patients were divided into 2 groups based on the chosen treatment method. Irreparability was defined intraoperatively as the inability to achieve sustainable repair of the SSP after complete release, typically corresponding to Goutallier classification of ≥ 3 and stage 3 in the Patte classification. The clinical assessment protocol involved measuring of range of motion (ROM), shoulder strength, Constant-Murley Score (CMS) and SST Scores. Radiological assessment comprised measurements of the Acromio-Humeral Index (AHI), the Hamada classification, the Sugaya's classification and Goutallier classification for both SSP and ISP. The study included data from 60 patients (30 in each group) with a mean age of 62.5 years and a mean follow-up of 34.5 months. The retear rate for PRLHBTA was 43.3% and 73.3% for PR alone (p=0.036). During the final examination statistically significant differences in favour of PRLHBTA were observed for: CMS 76.2±0.9 vs 70.9±11.5 (p=0.034), Sugaya's classification 3.5±1.1 vs 4.1±0.9 (p=0.035) and AHI 5.8±2mm vs 4.7±1.3 (p=0.021). There were no significant differences between the groups in patients' ROM, shoulder strength, the Hamada classification, Simple Shoulder Test (SST) and postoperative Goutallier scales. PR with LHBTA for patients with irreparable MRCT provides a lower retear rate and better humeral head centralization, and improved results measured by CMS compared to PR alone.