Long Head of the Biceps Tendon Augmentation in Massive Irreparable Rotator Cuff Tears Offers Good Clinical Results and Pain Relief With a Low Failure Rate

Background: Techniques incorporating the long head of the biceps tendon (LHBT) into repair of massive irreparable rotator cuff tears (MIRCTs) have been reported to present good clinical outcomes in a short-term follow-up, but there is a lack of studies with longer observation. Purpose: To assess clinical and radiologic results of LHBT redirection with margin convergence repair in patients with MIRCTs in a longer follow-up. Study Design: Case series; Level of evidence, 4. Methods: Patients with at least 2 years of follow-up were enrolled in this retrospective study. Shoulder range of motion, pain per the numeric rating scale, Constant score, and American Shoulder and Elbow Surgeons questionnaire were assessed. True anteroposterior radiographs were assessed regarding acromiohumeral distance and cuff tear arthropathy per Hamada and Favard classifications. Magnetic resonance imaging scans were analyzed regarding fatty infiltration of supraspinatus (SST) and infraspinatus (IST) according to Goutallier classification and LHBT–rotator cuff construct features. Results: The study group involved 45 patients (11 female, 34 male) with a mean age of 65 years (range, 50-77) and mean follow-up of 52 months (range, 24-100). One patient was excluded for reverse shoulder arthroplasty. The mean range of motion was 150° of flexion, 148° of abduction, and 35° of external rotation. The mean pain was 1.0. The mean results were 83.9 in American Shoulder and Elbow Surgeons questionnaire and 71.2 in Constant score. The mean acromiohumeral distance was 5.6 mm (range, 2.0-8.7). On radiographs, cuff tear arthropathy was assessed as grade 1 in 23 patients, grade 2 in 14, grade 3 in 3, and grade 4 in 4. Mild glenoid erosion was observed in 9 patients. Among 35 patients, significant fatty infiltration was observed and graded as 3 in 7 patients for SST and 10 patients for IST and graded as 4 in 1 for SST and 2 for IST. The LHBT was presented intra-articularly in 31 of 35 analyzed magnetic resonance imaging scans and as running directly to the greater tuberosity in 10 of 35. The SST was healed proximally to the LHBT in 28 of 35 patients. One complication (2.2%) and 4 (8.9%) clinical failures were observed. Conclusion: At follow-up >2 years, LHBT redirection provided excellent pain-free range of movement, even though muscle strength deficit persisted. The rate of complications and clinical failures seems to be lower than for other nonarthroplasty treatment options for MIRCT.