In the last few years, the long head of the biceps tendon has been attracting interest as an alternative graft choice for superior capsular reconstruction, but there hasn’t been a lot of data on its effectiveness until now.
Rotator Cuff: Long Head of the Biceps Autograft Prevents Re-tear
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#rotatorcuffrepairSecondary#superiorcapsularreconstruction#bicepsautograft
In a study that compared three surgical techniques for the treatment of massive posterosuperior retracted rotator cuff tears (RCTs), superior capsular reconstruction with longhead of the biceps autograft was found to be effective in preventing infraspinatus re-tear.
The study, “Superior Capsular Reconstruction With the Long Head of the Biceps Autograft Prevents Infraspinatus Retear in Massive Posterosuperior Retracted Rotator Cuff Tears,” was published on April 8, 2020 in The American Journal of Sports Medicine.
The surgical techniques analyzed between January 2007 and March 2017 were:
- double-row technique (DR), transosseous equivalent (TOE) technique with absorbable patch reinforcement, and
- superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) autograft.
The double-row technique refers to arthroscopic rotator repair using a double row of suture anchors. The transosseous-equivalent technique is also an arthroscopic procedure that is considered the “equivalent” to a traditional open suture-bridge technique.
A total of 82 patients were each assigned to one of the techniques (28 patients, DR; 30 patients, TOE+patch; 24 patients, SCR with LHBT).
According to the data collected, 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 post-op, 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 healthy in 75% of the DR group, 76.5% of the TOE+patch group, and 100% of the SCR with the LHBT group (p = .006).
The researchers wrote, “In cases of massive posterosuperior RCTS, SCR with the LHBT should be considered a reliable cost-effective treatment option that protects infraspinatus integrity.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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