Arthroscopic biceps augmentation does not improve clinical outcomes during incomplete repair of large to massive rotator cuff tears

Abstract

Aims This study compared patients who underwent arthroscopic repair of large to massive rotator cuff tears (LMRCTs) with isolated incomplete repair of the tear and patients with incomplete repair with biceps tendon augmentation. We aimed to evaluate the additional benefit on clinical outcomes and the capacity to lower the re-tear rate. Methods We retrospectively reviewed 1,115 patients who underwent arthroscopic rotator cuff repair for full-thickness tears between October 2011 and May 2019. From this series, we identified 77 patients (28 male, 49 female) with a mean age of 64.1 years (50 to 80). Patients were classified into groups A (n = 47 incomplete) and B (n = 30 with biceps augmentation) according to the nature of their reconstruction. Clinical scores were checked preoperatively and at six months, one year, and two years postoperatively. In preoperative MRI, we measured the tear size, the degree of fatty infiltration, and muscle volume ratio of the supraspinatus. In postoperative MRI, the integrity of the repaired rotator cuff tendon was assessed using the Sugaya classification. Tendon thickness at the footprint was evaluated on T2-weighted oblique coronal view. Results There were no significant differences in the initial preoperative demographic characteristics. In both groups, there were significant improvements in postoperative clinical scores (p < 0.001). However, most clinical outcomes, including range of motion measurements (forward elevation, external rotation, internal rotation, and abduction), showed no differences between the pre- and postoperative values. Comparing the postoperative outcomes of both groups, no further improvement from biceps augmentation was found. Group B, although not reaching statistical significance, had more re-tears than group A (30% vs 15%; p = 0.117). Conclusion In LMRCTs, biceps augmentation provided no significant improvement of an incomplete repair. Therefore, biceps augmentation is not recommended in the treatment of LMRCTs. Cite this article: Bone Joint J 2022;104-B(11):1234–1241.

Arthroscopic decompression of calcific tendinitis without cuff repair

“…12,15,16 Verhaegen et al 16 had both follow-up ultrasonography and MRIs performed after decompressing the calcific deposits with an arthroscope; the MRIs showed abnormalities in up to 76%, some of which were interpreted as ‘full-thickness’ tears. 22 Regardless of the findings relating to the rotator cuff, good improvement in clinical outcomes was observed. The clinical relevance of these findings is still uncertain.…”

Long Head of the Biceps Pediculated Autograft Augmentation of Arthroscopic Subscapularis Repair

“…Finally, in a retrospective study of a cohort of 77 patients comparing partial arthroscopic repair of low-mobility large to massive posterosuperior rotator cuff tears with and without incorporation of the LHBT, Park et al. 28 observed no statistically significant difference in the retear rate between both groups on follow-up MRI at 6 months after surgery, despite a retear rate decreased by half with the incorporation of the LHBT in the repair.…”

Arthroscopic superior capsule reconstruction augmentation using a semitendinosus autograft in massive reparable rotator cuff tears

“…Moreover, a recent study indicated that LHBT autograft augmentation may not sufficiently restore a stable fulcrum required for normal kinematics in patients with massive cuff tears. 49 …”

“… 48 However, LHBT autograft augmentation may not sufficiently restore a stable fulcrum required for normal kinematics. 49 Moreover, the LHBT is often damaged. 32 , 60 …”