Superior Capsular Reconstruction With the Long Head of the Biceps Autograft Prevents Infraspinatus Retear in Massive Posterosuperior Retracted Rotator Cuff Tears.

BACKGROUND

Materials and patches with increased biomechanical and biological properties and superior capsular reconstruction may change the natural history of massive rotator cuff tears (RCTs).

PURPOSE

To compare structural and clinical outcomes among 3 surgical techniques for the treatment of massive posterosuperior RCTs: double-row (DR) technique, transosseous-equivalent (TOE) technique with absorbable patch reinforcement, and superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) autograft.

STUDY DESIGN

Cohort study; Level of evidence 3.

METHODS

We retrospectively analyzed the 3 techniques in patients who underwent repair of massive posterosuperior RCTs between January 2007 and March 2017. All patients completed preoperative and 24-month postoperative evaluations: range of motion, subjective shoulder value, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale for pain, and Constant score. Tendon integrity was assessed with ultrasound 1 year postoperatively.

RESULTS

A total of 82 patients completed the final evaluation (28 patients, DR; 30 patients, TOE + patch; 24 patients, SCR with LHBT). Groups were statistically comparable preoperatively, except for active forward elevation and tendon retraction, which were significantly worse in the SCR group ( = .008 and = .001, respectively). After 24 months, the mean ± SD scores for the respective groups were as follows: 76 ± 10, 72 ± 15, and 77 ± 10 for the Constant score ( = .35); 84 ± 10, 84 ± 15, and 80 ± 15 for the ASES ( = .61); 9 ± 2, 9 ± 3, and 8 ± 3 for the Simple Shoulder Test ( = .23); 82 ± 15, 80 ± 18, and 75 ± 18 for the subjective shoulder value ( = .29); and 1.4 ± 1.7, 1.8 ± 2, and 1.4 ± 1.4 for the visual analog scale ( = .65). The strength of the operated shoulder was 4 ± 3 kg, 4.7 ± 3 kg, and 6.4 ± 1.6 kg for the DR, TOE + patch, and SCR groups, respectively ( = .006). At 12 months postoperatively, 60.7% (17 of 28) of the DR group, 56.7% (17 of 30) of the TOE + patch group, and 91.7% (22 of 24) of the SCR group remained healed on ultrasound. The infraspinatus tendon remained healed in 75% of the DR group, 76.5% of the TOE + patch group, and 100% of the SCR with the LHBT group ( = .006).

CONCLUSION

In cases of massive posterosuperior RCTs, SCR with the LHBT should be considered a reliable, cost-effective treatment option that protects infraspinatus integrity.