The treatment of massive and irreparable rotator cuff tears has long been a complex problem for shoulder joint surgeons. Due to muscle fat infiltration and tendon retraction, surgical repair of these tears is challenging, and some chronic, massive rotator cuff tears cannot be completely repaired. At present, there are many surgical treatment options available, including debridement and subacromial decompression, partial rotator cuff repair, allogeneic or autologous transplantation (patches, fascia, or dermis, etc.), tendon transposition (latissimus dorsi, pectoralis major, or pectoralis minor, etc.), balloon technique, and reverse total shoulder arthroplasty. For relatively younger patients, joint preservation surgery involving clearance and partial repair, patch enhancement, or tendon transfer remains the preferred option. If a complete repair cannot be achieved, a partial repair may still improve shoulder pain and function, but the risk of retearing after partial repair is as high as 52%. Compared with partial repair, arthroscopic patch augmentation has better clinical efficacy but offers no significant benefit to patients with high steatosis and has a relatively high nonunion rate. Tendon transposition of the latissimus dorsi and other muscles is also a good choice for clinical treatment. However, this surgical method is a non-anatomical transposition, and a large number of anchors need to be implanted during the operation, which causes significant trauma, a long recovery time for patients, and a high incidence of complications. Reverse shoulder arthroplasty is mainly suitable for elderly patients and can effectively improve pain and shoulder joint function in patients with advanced rotator cuff tear disease and/or painful pseudopalsy. However, the prosthesis has a limited lifespan, and complications such as postoperative infection, prosthesis loosening, and pad wear after replacement can occur, and it is expensive. The long head tendon of the biceps brachii is used as an autologous graft to reconstruct the upper joint capsule, exerting its tension-reducing scaffold function, enhancing the mechanical strength of the anterior tissue of the rotator cuff and exerting the anterior upper blocking effect, reducing the tissue tension of the repaired rotator cuff to promote the tendon-bone healing of the rotator cuff and prevent retear of the rotator cuff. Moreover, it has few complications, low cost, and a relatively simple surgical procedure, which are among its advantages.

To explore the efficacy of arthroscopic transposition and reinforcement of the long head tendon of the biceps brachii (LHBT) combined with partial rotator cuff repair in the treatment of massive and irreparable rotator cuff tears, and to compare the results with the one-year follow-up of arthroscopic partial rotator cuff repair (APR) alone.

A retrospective analysis was conducted on a total of 36 patients who underwent arthroscopic repair of massive and irreparable rotator cuff tears at Jiangsu Provincial Hospital of Chinese Medicine from August 2019 to June 2023. There were 20 cases in the partial repair group and 16 cases in the LHBT translocation combined with the partial repair group. The inclusion criteria were irreparable rotator cuff tears in which the tendon could not reach its original footprint, and the postoperative follow-up was 1 year. The active range of motion of the shoulder joint, visual analogue scale (VAS) for pain, UCLA score, American society of shoulder and elbow surgeons (ASES) score, and Constant-Murley score after surgery were compared between the two groups to assess postoperative complications. MRI was reexamined, and the Sugaya healing classification was used to assess the integrity of the reconstructed tissue.

There were no statistically significant differences in VAS and functional scores (UCLA, ASES, and Constant-Murley) for resting pain and motor pain at 1 month and at 3, 6, and 12 months after surgery between the two groups (P>0.05). Six months after the operation, there was no significant difference in the range of motion of forward flexion and upward lift between the two groups (P>0.05), but the range of motion of external rotation in the LHBT combined group was better than that in the APR group (P<0.05). MRI at 3, 6, and 12 months after the operation showed that the tendon-bone healing grades (Sugaya classification) and retear rates of the two groups were comparable (P>0.05) .

LHBT transposition enhancement combined with partial repair can more significantly improve postoperative active external rotation function in patients with massive, irreparable rotator cuff tears than APR alone. However, the efficacy of both is comparable in terms of forward flexion and elevation range of motion, pain relief, functional score, tendon-bone healing, and retreater rate.