Early clinical outcomes of arthroscopic long head of biceps tendon transposition repair versus complete repair for massive rotator cuff tears

Objective: Massive rotator cuff tears (mRCTs) have high re-tear rates and poor functional outcomes after traditional repair. This study compared early clinical outcomes after an arthroscopic tear with long head of biceps tendon (LHBT) transposition vs. complete repair (CR). Methods: In this study, a retrospective case series was completed in 45 patients with mRCTs that were confirmed via magnetic resonance imaging (MRI) and that underwent either LHBT transposition (n = 21; mean age, 58.5 Å} 8.6 years) or CR (n = 24; mean age, 55.2 Å} 8.4 years) between May 2019 and December 2021. Outcome measures included acromiohumeral distance (AHD), Visual Analog Scale, constant score (CS), University of California, Los Angeles (UCLA) score, and forward elevation. Re-tear rates were measured via postoperative MRI and clinical findings. Results: The groups were similar with respect to perioperative variables (all P > .05). At both 6 months and 12 months, the LHBT group had significantly greater AHD (7.76 Å} 0.56 mm vs. 7.31 Å} 0.74 mm, P = .028; 7.16 Å} 0.56 mm vs. 6.50 Å} 1.04 mm, P = .014). Visual Analog Scale scores were lower in the LHBT group at 6 months (2.95 Å} 0.50 vs. 3.88 Å} 1.33, P = .031), 12 months (1.67 Å} 0.58 vs. 2.79 Å} 1.59, P = .022), and final follow-up (1.19 Å} 0.40 vs. 2.04 Å} 1.85, P = .018). Functional scores were improved with CS and UCLA scores being higher in the LHBT group at both 12 months and follow-up (P = .029-.034). The rate of re-tear was lower with LHBT (19.1% vs. 58.3%, P = .014). Conclusion: Arthroscopic LHBT transposition provides better pain relief, functional recovery, structural preservation, and lower re-tear rates compared to CR. Therefore, LHBT transposition is a clinically appropriate alternative, especially in patients who are at high risk of re-tear. Cite this article as: Dong X, Deng J, Wang B, Li F, Ruan S, Bai F. Early clinical outcomes of arthroscopic long head of biceps tendon transposition repair versus complete repair for massive rotator cuff tears. Acta Orthop Traumatol Turc., 2026; 60(3), 0500, doi: 10.5152/j.aott.2026.25500.