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Randomized Controlled Trial
. 2025 May 7;107(9):e41.
doi: 10.2106/JBJS.24.00423. Epub 2025 Mar 27.

Preservation Versus Release of Normal Long Head of Biceps Tendon in Repair of Isolated Stage-1 Supraspinatus Tears: Preservation Leads to Slightly Lower Constant-Murley Scores and More Reoperations

Julien Berhouet  1 , Adrien Jacquot  2 , François Gadéa  3 , Jacques Guery  4 , Thierry Joudet  5 , Nicolas Bonnevialle  6 , Xavier Ohl  7 , Lionel Neyton  8 , Nicolas Gasse  9 , Johannes Barth  10 , Maxime Antoni  11 , Franck Dordain  12 , David Gallinet  6 , Christophe Charousset  13 ; The Francophone Arthroscopy Society (SFA)
Collaborators, Affiliations
Randomized Controlled Trial

Preservation Versus Release of Normal Long Head of Biceps Tendon in Repair of Isolated Stage-1 Supraspinatus Tears: Preservation Leads to Slightly Lower Constant-Murley Scores and More Reoperations

Julien Berhouet et al. J Bone Joint Surg Am. .

Abstract

Background: The aim of this study was to determine whether preserving a normal-appearing long head of the biceps (LHB) tendon leads to better Constant-Murley scores (CMS) than releasing it in patients undergoing arthroscopic repair of an isolated stage-1 supraspinatus tendon tear.

Methods: Patients (40 to 70 years old) who were undergoing arthroscopic repair of a minor supraspinatus tendon tear and who had a macroscopically normal LHB were randomized to LHB preservation or LHB release during a prospective clinical trial. The surgeon was free to choose whether to perform tenodesis in patients undergoing LHB release. The primary outcome was the involved shoulder's function based on the absolute CMS score at 6 and 24 months. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) shoulder score and Subjective Shoulder Value (SSV). A post-hoc analysis of prospectively collected data was done using 1:1 propensity score matching without replacement. This resulted in 2 age- and sex-matched groups of 95 patients each. Race and ethnicity data were not collected.

Results: At 24 months, the mean CMS was significantly better in the LHB release group (mean and standard deviation, 86.8 ± 8.3) than in the LHB preservation group (82.9 ± 10.0) (p = 0.003), 97% of the patients in the LHB release group and 88% in the LHB preservation group had more than the minimal clinically important difference (MCID) for the CMS in rotator cuff repair (p = 0.048), 15% in the LHB preservation group and 3% in the LHB release group (p = 0.01) had an absolute CMS below 70, and the ASES was significantly higher in the LHB release group (91.4 ± 19.2) than in the LHB preservation group (83.6 ± 25.0) (p = 0.02). There were 4 reoperations in the LHB preservation group and no reoperations in the LHB release group.

Conclusions: Based on our findings, a macroscopically normal-appearing biceps tendon should be released when treating stage-1 supraspinatus tendon tears.

Level of evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: No external funding was received for this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I503 ).

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