Superior Capsular Reconstruction With the Long Head of the Biceps Autograft Prevents Infraspinatus Retear in Massive Posterosuperior Retracted Rotator Cuff Tears

Background: Materials and patches with increased biomechanical and biological properties and superior capsular reconstruction may change the natural history of massive rotator cuff tears (RCTs). Purpose: To compare structural and clinical outcomes among 3 surgical techniques for the treatment of massive posterosuperior RCTs: double-row (DR) technique, transosseous-equivalent (TOE) technique with absorbable patch reinforcement, and superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) autograft. Study Design: Cohort study; Level of evidence 3. Methods: We retrospectively analyzed the 3 techniques in patients who underwent repair of massive posterosuperior RCTs between January 2007 and March 2017. All patients completed preoperative and 24-month postoperative evaluations: range of motion, subjective shoulder value, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale for pain, and Constant score. Tendon integrity was assessed with ultrasound 1 year postoperatively. Results: A total of 82 patients completed the final evaluation (28 patients, DR; 30 patients, TOE + patch; 24 patients, SCR with LHBT). Groups were statistically comparable preoperatively, except for active forward elevation and tendon retraction, which were significantly worse in the SCR group (P = .008 and P = .001, respectively). After 24 months, the mean +/- SD scores for the respective groups were as follows: 76 +/- 10, 72 +/- 15, and 77 +/- 10 for the Constant score (P = .35); 84 +/- 10, 84 +/- 15, and 80 +/- 15 for the ASES (P = .61); 9 +/- 2, 9 +/- 3, and 8 +/- 3 for the Simple Shoulder Test (P = .23); 82 +/- 15, 80 +/- 18, and 75 +/- 18 for the subjective shoulder value (P = .29); and 1.4 +/- 1.7, 1.8 +/- 2, and 1.4 +/- 1.4 for the visual analog scale (P = .65). The strength of the operated shoulder was 4 +/- 3 kg, 4.7 +/- 3 kg, and 6.4 +/- 1.6 kg for the DR, TOE + patch, and SCR groups, respectively (P = .006). At 12 months postoperatively, 60.7% (17 of 28) of the DR group, 56.7% (17 of 30) of the TOE + patch group, and 91.7% (22 of 24) of the SCR group remained healed on ultrasound. The infraspinatus tendon remained healed in 75% of the DR group, 76.5% of the TOE + patch group, and 100% of the SCR with the LHBT group (P = .006). Conclusion: In cases of massive posterosuperior RCTs, SCR with the LHBT should be considered a reliable, cost-effective treatment option that protects infraspinatus integrity.