Abstract Purpose To retrospectively assess the clinical outcomes of the patients with large to massive reparable rotator cuff tears (RCTs) treated by arthroscopic rotator cuff repair (ARCR) combined with modified superior capsule reconstruction (mSCR) using the long head of biceps tendon (LHBT) as reinforcement with a minimum of 2 years of follow-up. Methods We retrospectively evaluated 40 patients with large to massive reparable RCTs who underwent ARCR and mSCR (Group I) between February 2017 and June 2018 (18 patients) or underwent ARCR and tenotomy of LHBT performed at the insertion site (Group II) between January 2015 and January 2017 (22 patients). The pain visual analog score (VAS) was assessed preoperatively and 1, 3, 6, 12, 24 months postoperatively. American Shoulder and Elbow Surgeons (ASES) scores, the University of California, Los Angeles (UCLA) shoulder rating scale, and active range of motion (AROM) were assessed preoperatively and 6, 12, and 24 months postoperatively. The integrity of the rotator cuff and mSCR was evaluated using magnetic resonance images at 12 months postoperatively. Results After surgery, both groups had significantly improved in VAS, ASES, UCLA and AROM scores in the final follow-up. There were no significant between-group differences in the characteristics of the patients prior to surgery. Group I had improved pain relief at 1 month (p Conclusions ARCR combined with mSCR using LHBT as reinforcement may lead to a lower retear rate and earlier functional recovery than conventional ARCR with tenotomy of LHBT for large to massive reparable RCTs. Level of Evidence Level III, retrospective therapeutic comparative trial Clinical Relevance ARCR + mSCR could be an alternative treatment option for patient with large to massive reparable rotator cuff tears.

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