Reconstruction of the Superior Capsule Using Peroneus Longus Tendon Graft Combined With Transposition of Biceps Tendon for Irreparable Massive Rotator Cuff Tears

Background: Traditional superior capsular reconstruction (SCR) with biceps tendon transposition (TB) alone for irreparable massive rotator cuff tears (IMRCTs) has demonstrated a high retear rate, highlighting the need for alternative approaches. Therefore, SCR using a peroneus longus tendon graft (PLG) combined with TB (PLG-TB) should be clinically studied.Purpose: To compare the clinical and radiological outcomes of SCR using the PLG-TB technique versus the TB technique alone for IMRCT.Study Design: Cohort study; Level of evidence, 3.Methods: Between February 2017 and March 2022, 94 patients were diagnosed with IMRCT; 45 patients underwent SCR using the TB technique (group 1), and 49 patients underwent SCR using the PLG-TB technique (group 2). The choice of technique was based on tendon damage severity and patient preference. After a minimum follow-up period of 2 years, postoperative clinical outcomes were compared using the American Shoulder and Elbow Surgeons (ASES); University of California, Los Angeles (UCLA); Constant; and visual analog scale (VAS) for pain scores as well as the shoulder range of motion. The integrity of tendons, acromiohumeral distance, and retear was evaluated through magnetic resonance imaging (MRI).Results: The mean follow-up times were 35.2 +/- 4.2 months for group 1 and 34.1 +/- 3.2 months for group 2. There was a significant improvement observed in all clinical outcomes in both groups from the baseline preoperative evaluations to the final follow-up assessments (P = .001 for ASES score, UCLA score, Constant score, VAS score, forward flexion, abduction, and external rotation). Shoulder abduction in group 2 showed statistically significant mean improvements at the postoperative 3-month, 6-month, and final follow-ups compared with group 1 (3 months: 105.17 degrees +/- 7.13 degrees vs 89.34 degrees +/- 7.34 degrees [P = .001]; 6 months: 138.14 degrees +/- 9.12 degrees vs 107.35 degrees +/- 8.54 degrees [P = .001]; final follow-up: 157.35 degrees +/- 8.11 degrees vs 135.31 degrees +/- 7.01 degrees [P = .001]). The tendon integrity at the final follow-up (Sugaya MRI grades 1/2/3/4/5) was significantly better in group 2 (30/6/6/4/3) compared with group 1 (11/13/5/6/10) (P = .014). Additionally, the tendon retear rate was lower in group 2 (7/49; 14.29%) than in group 1 (16/45, 35.56%) (P = .015).Conclusion: Both surgical techniques led to acceptable clinical outcomes in patients with IMRCT. However, using the PLG-TB technique for SCR was associated with lower retear rates and enhanced abduction function outcomes compared with the TB technique for SCR.