Preoperative predictors of graft retear following arthroscopic superior capsule reconstruction with long head of biceps tendon autograft: a pilot retrospective case-control study

Background: Superior capsule reconstruction (SCR) using the long head of the biceps tendon (LHBT) is a joint-preserving option for large-to-massive rotator cuff tears, but predictors of graft retear remain incompletely characterized. We aimed to identify preoperative clinical and imaging predictors of retear after arthroscopic LHBT-SCR. Methods: A retrospective pilot case-control study was conducted at two tertiary orthopedic centers. Cases had confirmed graft retear (Sugaya type IV-V on postoperative magnetic resonance imaging); controls had an intact graft and were sampled at an approximate 2:1 ratio. Forty patients were included and followed for a median of 24 months (range, 12-26 months). Preoperative variables included age, sex, tear dimensions, Hamada grade, Goutallier grade, and functional scores (Constant-Murley, American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA]). A forced-entry multivariable logistic model with three predictors was fitted; thresholds were derived using the Youden index. Results: Fourteen cases and 26 controls were identified. Preoperative Constant-Murley (median, 23.1 vs. 35.1; P=0.014), ASES (25.8 vs. 35.0; P=0.020), and UCLA (9.0 vs. 11.0; P=0.021) scores were lower in the retear group. Tear morphology did not differ between groups. The multivariable model (ASES, Goutallier grade, forward elevation; complete-case n=38) achieved an apparent area under the curve (AUC) of 0.811 (bootstrap optimism-corrected AUC, 0.754). Despite structural failure, both groups achieved equivalent functional recovery, with all patients exceeding their minimal clinically important differences. Conclusions: Preoperative functional impairment was the primary correlate of graft retear after LHBT-SCR. Prospective validation in a larger case-control study (target n=132) is warranted. Level of evidence: IV.