Arthroscopic biceps augmentation for avoiding undue tension in repair of massive rotator cuff tears

Abstract

Purpose: The purpose of our study was to evaluate the outcome of massive rotator cuff tears repaired by use of an arthroscopic biceps augmentation technique, interpositioning the tenotomized biceps tendon to bridge the gap between the torn edges of the cuff tendon.

Methods: Sixty-eight shoulders with massive rotator cuff tears were included in this study. Arthroscopic rotator cuff repairs with the biceps augmentation technique were performed in 37 patients (group A), whereas 31 patients underwent repair without biceps augmentation (group B). The mean follow-up period was 21 months (range, 14 to 78 months) in group A and 20 months (range, 13 to 63 months) in group B.

Results: The mean University of California, Los Angeles score improved from 14.1 points (range, 6 to 21 points) in group A and 13.9 points (range, 7 to 22 points) in group B preoperatively to 32.6 points (range, 22 to 35 points) and 30.3 points (range, 20 to 35 points) postoperatively, respectively (P < .001 and P < .001, respectively). However, the difference between the postoperative scores was not statistically significant (P = .198). At the last follow-up, group A showed better results than group B in forward flexion, external rotation, and internal rotation strength, with statistically significant differences (P = .017, P = .001, and P < .001, respectively). According to the postoperative repair integrity analyzed by use of magnetic resonance imaging, 58.3% of group A cases (14/24) and 26.3% of group B cases (5/19) had complete healing (P = .036).

Conclusions: An arthroscopic augmentation technique using the tenotomized biceps tendon was effective in achieving fewer structural failures, equivalent clinical outcomes, and significant improvement in muscle strength in comparison traditional arthroscopic repairs by avoiding undue tension in cases with massive rotator cuff tear.