Arthroscopic repair of large and massive rotator cuff tears using the biceps-incorporating technique: mid-term clinical and anatomical results

Introduction: The purpose of this study was to determine the anatomical and clinical outcomes of a biceps-incorporating rotator cuff repair without detaching the biceps origin from the glenoid in a large or massive rotator cuff tear, in which the biceps tendon could be incorporated into the cuff defect and help to provide tendon healing and prevent upward migration of the humeral head.

Materials and methods: Thirty-five consecutive patients with a mean age of 62 years (41–81 years) had primary arthroscopic repair of their large or massive rotator cuff in which biceps tendon incorporated into the cuff defect without detaching the biceps tendon from the glenoid was performed. Functional outcome was determined by the visual analog scale (VAS) for pain during motions, simple shoulder test (SST), the University of California, Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons scores (ASES) (mean follow-up, 24 months). The continuity of rotator cuff mechanism was evaluated using the magnetic resonance imaging (MRI) among all the patients after 2 years.

Level of evidence: Level IV retrospective review.

Results: At the final follow-up, mean VAS scores increased significantly from 7.1 to 2.0 points, ASES scores from 35 to 83, UCLA scores from 14 to 30, and SST scores from 4 to 9, respectively (p < 0.05). Moreover, the range of motion was significantly increased except the external rotation from preoperative 27° to postoperative 33° (p = 0.183). MRI evaluation showed that 22 of 35 patients (63 %) had heeled tendons and 7 patients (20 %) had partial re-tear. Of 35 patients, 6 (17 %) had a complete re-tear. Only 3 of these 6 patients were not satisfied with the result.

Conclusions: Using this simple biceps-incorporating rotator cuff repair technique, we achieved good clinical and moderate anatomical results, and prevent superior migration of the humeral head in a large or massive rotator cuff tear.