Clinical outcomes of superior capsular reconstruction using the long head of the biceps tendon for irreparable rotator cuff tears: a 1-year follow-up study

Irreparable rotator cuff tears (RCT) still remain challenging for surgeons because retracted tendons and fatty infiltration may lead to poor healing after reconstruction of the rotator cuff. The aim of this study was to present the 1‑year follow-up results of superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT) and to check the integrity of the reconstruction.

From 2019 to 2020, 23 patients with an irreparable posterosuperior RCT were treated using SCR with the LHBT as a graft. Postoperative clinical examination included assessment of the range of motion (ROM) and strength to compare the pre- and postoperative conditions. Standardized scores (Constant Score [CS], Disabilities of the Arm, Shoulder and Hand Questionnaire [DASH], Western Ontario Rotator Cuff Index [WORC], Subjective Shoulder Value [SSV]) were collected for subjective evaluation. The integrity of the LHBT as a graft was evaluated 1 year postoperatively through magnetic resonance imaging (MRI).

The median follow-up was 13.6 months (interquartile range [IQR]: 1.6), the mean age of the patients was 62.8 ± 8.1 years (range: 47–78). Active flexion improved significantly from 110.0° ± 53.9° to 153.9° ± 26.0 (p = 0.002) and active abduction from 106.1° ± 54.3 to 146.1° ± 35.0 (p = 0.008). At the final follow-up, the CS was 66.0 ± 11.7; the median DASH was 16.7 (IQR: 31.7) and the WORC was 79.1% (IQR: 31). The SSV improved from 42.4% ± 18.1 to 73.9% ± 14.0 (p < 0.001). In 16 out of 19 cases, the graft remained intact on the postoperative MRI.

Arthroscopic SCR with the LHBT showed promising results at the 1‑year follow-up. Further follow-up is needed with long-term results to determine whether the surgery can be considered a better treatment option for irreparable RCTs because of its cost and time savings and the absence of graft harvesting morbidity.