OTSR - 2026-04-23 - Journal Article
Superior Capsule Reconstruction with Long Biceps Plus Infraspinatus Partial Repair vs Isolated Biceps Tenotomy in Massive, Irreparable Rotator Cuff Tears.
Barret H, Mathieu E, Martinel V, Wong P, Rialet Q, Mansat P, Bonnevialle N
Topics
Key Takeaway
SCR using the long biceps tendon plus infraspinatus partial repair achieved a Constant score of 71 vs. 57 points and preserved acromiohumeral distance (9.8 mm) compared to isolated biceps tenotomy (7.4 mm) at mean 28 months in massive irreparable rotator cuff tears.
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Summary
This single-center retrospective cohort compared SCR using the long biceps tendon with infraspinatus partial repair versus isolated biceps tenotomy in 37 patients with massive irreparable posterosuperior cuff tears at minimum 2-year follow-up. SCRLB outperformed ToLB across all clinical metrics: Constant score 71 vs. 57 (p=0.001), VAS pain 0.7 vs. 3.9 (p<0.001), SSV 86% vs. 63% (p<0.001), and anterior elevation 157° vs. 137° (p=0.012). Acromiohumeral distance was maintained in the SCRLB group (10 to 9.8 mm, p=0.2) but declined significantly in the ToLB group (9.8 to 7.4 mm, p=0.003), with 5 ToLB patients requiring conversion to reverse shoulder arthroplasty.
Key Limitation
With only 18–19 patients per group, the study is underpowered to detect clinically meaningful subgroup differences by tear pattern, fatty infiltration grade, or patient age, limiting generalizability of the outcome advantage.
Original Abstract
AIMS
The surgical management of massive, irreparable rotator cuff tears remains controversial. The aim was to evaluate the short-term clinical and radiological outcomes of Superior Capsule Reconstruction (SCR) with Long Biceps Plus Partial Repair versus isolated tenotomy (ToLB) of the long head of biceps tendon.
METHODS
This was a single-center continuous study of patients with irreparable posterosuperior cuff tears, who underwent SCR (posterior transposition of the long biceps and partial repair of the infraspinatus) or ToLB, and had a minimum follow-up of 2 years. Clinical outcomes were Constant score active range of motion, VAS for pain and Subjective Shoulder Value (SSV). Acromiohumeral distance was measured on A/P radiographs before surgery and at the last follow-up visit.
RESULTS
Thirty-seven patients (mean age 66 ± 9 years) were included: 19 SCRLB (Superior Capsule Reconstruction with Long Biceps), 18 ToLB. The two groups were comparable in terms of age and type of cuff tears. At a mean follow-up of 28 ± 12 months, the SCRLB group had better shoulder Constant score than the ToLB group: 71 ± 21 points vs. 57 ± 14 points (p = 0.001). Mobilities was better in SCRLB group than the ToLB group: anterior elevation 157 ± 15° vs. 137 ± 28° (p = 0.012), external rotation 51 ± 14° vs. 41 ± 15° (p = 0.04), internal rotation 9 ± 1.5 points vs. 8 ± 2 points (p = 0.034). Pain on VAS was 0.7 ± 1.3 points vs. 3.9 ± 2.3 points (p < 0.001) and SSV score was 86 ± 11% vs. 63 ± 17% (p < 0.001) in the SCRLB and ToLB groups, respectively. No revisions were needed in the SCRLB group. In the ToLB group, 5 patients required reverse shoulder arthroplasty. The acromiohumeral distance was stable overtime in the SCRLB group (10 ± 1.6 vs. 9.8 ± 2 mm, p = 0.2), decreased in the ToLB group (9.8 ± 2 vs. 7.4 ± 2.4 mm, p = 0.003).
CONCLUSION
At 2 years of follow-up in this series, SCR with the long head of the biceps combined with partial repair of the rotator cuff seems to give better clinical and radiological results than isolated tenotomy. Comparative studies with larger numbers of patients per group are needed to confirm these results.
LEVEL OF EVIDENCE
III; therapeutic, retrospective cohort study.