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Biceps-incorporating rotator cuff repair with footprint medialization in large-to-massive rotator cuff tears

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In large-to-massive rotator cuff tears (MRCTs), incorporating the long head of the biceps tendon (LHBT) with arthroscopic partial rotator cuff and margin convergence can improve clinical outcomes and preserve the acromio-humeral interval (AHI) during mid-term follow-up. The purpose of this study was to evaluate mid-term clinical and radiological outcomes of arthroscopic biceps-incorporating rotator cuff repair with partial release of the LHBT and footprint medialization through the Neviaser portal in MRCTs.

Methods

This study enrolled 107 patients (38 males and 69 females, mean age: 64.9 ± 8.6 years) with MRCTs. A novel arthroscopic biceps-incorporating repair was performed by footprint medialization, with a partially released biceps tendon covering central defects. Clinical outcomes such as pain VAS, KSS, ASES, UCLA, SST and CS scores and ROM were evaluated at a mean follow-up time of 35 months (range 12–132 months). Serial radiographs with a mean postoperative MRI follow-up duration of 33 months were used to evaluate AHI, tendon integrity, fatty infiltration (FI) and muscle hypotrophy.

Results

Postoperative pain VAS, KSS, ASES, UCLA, SST, and CS scores and ROM (except external rotation) were improved significantly. AHI also improved significantly from 8.6 to 9.3 mm. According to Sugaya’s classification, type I, II, III, IV, or V healing status was found in 30 (28.0%), 29 (27.1%), 26 (24.3%), 14 (13.1%), and 8 (7.5%) patients, respectively. The retear rate was 22 (20.6%).

Conclusions

Novel biceps-incorporating cuff repair with footprint medialization yielded satisfactory outcomes in MRCT patients at the 3-year follow-up. A partially released, repaired biceps tendon provided superior stability with preserved AHI similar to that of anterior cable reconstruction.

Level of evidence

IV

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Funding

There was no outside funding or grants received that assisted in this study.

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Authors and Affiliations

  1. Joint Center, Department of Orthopedic Surgery, Shinsegae Seoul Hospital, 841, Gyeongin-ro, Yeongdeungpo-gu, Seoul, 07305, Republic of Korea

    Jin Hwa Jeong

  2. Department of Orthopedic Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea

    Eun Ji Yoon, Bo Seoung Kim & Jong-Hun Ji

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Correspondence to Jong-Hun Ji.

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Approval for this study was granted by the Institutional Review Board of our hospital (IRB #: DC20RISI0029).

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167_2021_6829_MOESM1_ESM.tif

Supplementary file1 Supplementary Figure 1. MRI findings of arthroscopic biceps-incorporating rotator cuff repair. Preoperative MRI shows severely retracted massive rotator cuff tears (Patte classification 3) (A,B). Postoperative 1-year follow-up MRI showed intact cuff integrity (large arrow) with footprint medialization (arrow) after arthroscopic biceps-incorporating suture bridge rotator cuff repair (TIF 15799 KB)

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Jeong, J.H., Yoon, E.J., Kim, B.S. et al. Biceps-incorporating rotator cuff repair with footprint medialization in large-to-massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 30, 2113–2122 (2022). https://doi.org/10.1007/s00167-021-06829-9

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  • DOI: https://doi.org/10.1007/s00167-021-06829-9

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