Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon Rerouting for Massive Irreparable Posterosuperior Rotator Cuff Tear: A Retrospective Analysis

Background: In cases of massive irreparable posterior-superior rotator cuff tears (MIPSRCTs), the results of lower trapezius tendon transfer (LTTT), which acts as a dynamic stabilizer of the glenohumeral joint, can be augmented by superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT). The LHBT acts as a static stabilizer and augments the mechanical advantage of the transfer by enhancing the resistance to superior migration of the humeral head proximally. Purpose: To compare the results of arthroscopic-assisted lower trapezius tendon transfer (aaLTTT) with or without SCR using the LHBT in cases of MIPSRCT. Study Design: Cohort study; Level of evidence, 3. Methods: All patients with MIPSRCT between January 1, 2018, and March 2022 were retrospectively analyzed. They were divided into 2 groups. Group A included all patients with MIPSRCT who were treated with aaLTTT using SCR with LHBT. Group B included all patients with MIPSRCT who were treated by aaLTTT alone. Patients with a healthy and structurally intact LHBT underwent SCR in conjunction with LTTT. The results were assessed using the Subjective Shoulder Value (SSV), Constant-Murley score (CMS), Shoulder Pain and Disability Index (SPADI), active range of motion (AROM), acromiohumeral distance, motor power of shoulder movements, and patient satisfaction, as well as their ability to return to work. Results: The study included 60 patients, 30 patients in each group. There were 28 men (46.7%) and 32 women (53.3%), with a mean age of 53.4 ± 5.9 years (range, 36-64 years). The mean follow-up period was 30.0 ± 3.6 months (24-38 months). All patients experienced significant improvement in their self-reported shoulder condition (SSV) and reduction in their pain level (visual analog scale). There was no significant difference between the groups in either parameter. Regarding their functional outcome, patients in both groups had a significant increase in their CMS (group A: 39.5 ± 9.3 preoperative, 88.4 ± 0.7 at 24 months; group B: 36.4 ± 6.3, 72.4 ± 5.5) and a significant decrease in their SPADI (group A: 71.5 ± 9.4 preoperative, 19.2 ± 2.6 at 24 months; group B: 75.0 ± 7.0, 30.3 ± 4.9), but patients in group A had significantly better results than group B ( P < .001). All affected AROM aspects improved in both groups. This improvement was significantly greater in the LHBT SCR group (treatment group, A) regarding abduction (158.5°± 4.8° vs 116.7°± 11.6°, P < .001) and external rotation in abduction (73.1°± 2.5° vs 56.2°± 4.2°, P < .001) at a 2-year follow-up.Patient satisfaction was significantly higher among group A patients (A: 90% vs B: 73.3%, P < .001) while no significant difference occurred in their rate of returning to the same work (A: 60% vs B: 66%, P = .38). Conclusion: aaLTTT augmented with LHBT SCR can be a sound option in the treatment of MIPSRCT with the potential to enhance patients’ functional outcome, satisfaction, and AROM with no increased risk of complications or morbidity.