Skip to main content

Advertisement

SpringerLink
Log in

Satisfactory functional and structural outcomes of anterior cable reconstruction using the proximal biceps tendon for large retracted rotator cuff tears

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Large retracted anterior L-shaped tear characterized by a retracted supraspinatus tendon to the glenoid level combined with a relatively preserved infraspinatus tendon is one of the challenging tear patterns in achieving complete repair to the anatomic footprint. The purpose of this study was to evaluate clinical outcomes and tendon integrity of rotator cuff repair combined with anterior cable reconstruction using the proximal biceps tendon in patients with large retracted anterior L-shaped rotator cuff tear.

Methods

This study prospectively enrolled patients who underwent arthroscopic anterior cable reconstruction using the proximal biceps tendon for large retracted anterior L-shaped rotator cuff tears between 2018 and 2020 with a minimum 2-year follow-up. The anterior portion of the rotator cable was reconstructed using tenotomized proximal biceps tendon fixed with two suture anchors at the footprint. The retracted supraspinatus tendon was repaired on the biceps tendon without undue tension. The proximal portion of the infraspinatus tendon was repaired with the biceps tendon-supraspinatus tendon complex. Clinical outcomes was assessed during the follow-up period. Tendon integrity and retear size were evaluated by postoperative MRI.

Results

A total of 32 consecutive patients were included. The ASES score was significantly improved from 66.6 ± 16.6 preoperatively to 94.1 ± 6.1 postoperatively (P < 0.001), and the VAS for pain was significantly relieved from 2.8 ± 1.9 preoperatively to 0.5 ± 0.4 postoperatively (P < 0.001). All patients were satisfied postoperatively regardless of tendon integrity (P = 0.015). Postoperative ROM was increased continuously during the follow-up period (P < 0.001). The Popeye sign was found in 4 patients (12.5%). Six patients (18.7%) had rotator cuff retears. However, the ASES score of patients with retear was significantly improved from 72.8 ± 13.3 preoperatively to 91.1 ± 6.7 postoperatively (P < 0.001). Relative changes in the retear size compared with the primary tear size were -56.8 ± 14.4% for the anteroposterior diameter and – 70.6 ± 6.1% for the mediolateral diameter.

Conclusions

Rotator cuff repair combined with anterior cable reconstruction using the proximal biceps tendon provided satisfactory clinical and radiological outcomes for large retracted anterior L-shaped tears. Anterior cable reconstruction using the proximal biceps tendon is a sound surgical option for the patients with large retracted anterior rotator cuff tear.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bailey JR, Kim C, Alentorn-Geli E, Kirkendall DT, Ledbetter L, Taylor DC, Toth AP, Garrigues GE (2019) Rotator cuff matrix augmentation and interposition: a systematic review and meta-analysis. Am J Sports Med 47(6):1496–1506

    Article  PubMed  Google Scholar 

  2. Barber FA, Burns JP, Deutsch A, Labbé MR, Litchfield RB (2012) A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthroscopy 28(1):8–15

    Article  PubMed  Google Scholar 

  3. Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A (1994) Partial repair of irreparable rotator cuff tears. Arthroscopy 10(4):363–370

    Article  CAS  PubMed  Google Scholar 

  4. Chen RE, Bakhsh WR, Lipof JS, McVicker ZG, Voloshin I (2020) Rotator cuff anterior cable reconstruction with long head of biceps tendon autograft. Arthrosc Tech 9(6):e711–e715

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cho NS, Moon SC, Hong SJ, Bae SH, Rhee YG (2017) Comparison of clinical and radiological results in the arthroscopic repair of full-thickness rotator cuff tears with and without the anterior attachment of the rotator cable. Am J Sports Med 45(11):2532–2539

    Article  PubMed  Google Scholar 

  6. Cho NS, Yi JW, Rhee YG (2009) Arthroscopic biceps augmentation for avoiding undue tension in repair of massive rotator cuff tears. Arthroscopy 25(2):183–191

    Article  PubMed  Google Scholar 

  7. Davidson J, Burkhart SS (2010) The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthroscopy 26(3):417–424

    Article  PubMed  Google Scholar 

  8. Davidson PA, Rivenburgh DW (2000) Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elbow Surg 9(6):502–506

    Article  CAS  PubMed  Google Scholar 

  9. De Giacomo AF, Park MC, Lee TQ (2021) Anterior cable reconstruction using the proximal biceps tendon for large rotator cuff defects. Arthrosc Tech 10(3):e807–e813

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gilot GJ, Alvarez-Pinzon AM, Barcksdale L, Westerdahl D, Krill M, Peck E (2015) Outcome of large to massive rotator cuff tears repaired with and without extracellular matrix augmentation: a prospective comparative study. Arthroscopy 31(8):1459–1465

    Article  PubMed  Google Scholar 

  11. Haleem A, Gohal C, Leroux T, Henry P, Alolabi B, Khan M (2021) Primary arthroscopic repair of massive rotator cuff tears results in significant improvements with low rate of re-tear. Knee Surg Sports Traumatol Arthrosc 29(7):2134–2142

    Article  PubMed  Google Scholar 

  12. Hersche O, Gerber C (1998) Passive tension in the supraspinatus musculotendinous unit after long-standing rupture of its tendon: a preliminary report. J Shoulder Elbow Surg 7(4):393–396

    Article  CAS  PubMed  Google Scholar 

  13. Jeon YS, Lee J, Kim RG, Ko YW, Shin SJ (2017) Does additional biceps augmentation improve rotator cuff healing and clinical outcomes in anterior L-shaped rotator cuff tears? Clinical comparisons with arthroscopic partial repair. Am J Sports Med 45(13):2982–2988

    Article  PubMed  Google Scholar 

  14. Jeong JH, Yoon EJ, Kim BS, Ji JH (2022) Biceps-incorporating rotator cuff repair with footprint medialization in large-to-massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 30(6):2113–2122

    Article  PubMed  Google Scholar 

  15. Jerosch J, Castro WH (1993) Stress on the rotator cuff sutures in relation to joint position. Z Orthop Ihre Grenzgeb 131(4):317–322

    Article  CAS  PubMed  Google Scholar 

  16. Kim C, Lee YJ, Kim SJ, Yoon TH, Chun YM (2020) Bone marrow stimulation in arthroscopic repair for large to massive rotator cuff tears with incomplete footprint coverage. Am J Sports Med 48(13):3322–3327

    Article  PubMed  Google Scholar 

  17. Kim SJ, Lee IS, Kim SH, Lee WY, Chun YM (2012) Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy 28(6):761–768

    Article  PubMed  Google Scholar 

  18. Koh KH, Laddha MS, Lim TK, Park JH, Yoo JC (2012) Serial structural and functional assessments of rotator cuff repairs: do they differ at 6 and 19 months postoperatively? J Shoulder Elbow Surg 21(7):859–866

    Article  PubMed  Google Scholar 

  19. Lee GW, Kim JY, Lee HW, Yoon JH, Noh KC (2022) Clinical and anatomical outcomes of arthroscopic repair of large rotator cuff tears with allograft patch augmentation: a prospective, single-blinded, randomized controlled trial with a long-term follow-up. Clin Orthop Surg 14(2):263–271

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee S, Park I, Lee HA, Shin SJ (2020) Factors related to symptomatic failed rotator cuff repair leading to revision surgeries after primary arthroscopic surgery. Arthroscopy 36(8):2080–2088

    Article  PubMed  Google Scholar 

  21. Mesiha MM, Derwin KA, Sibole SC, Erdemir A, McCarron JA (2013) The biomechanical relevance of anterior rotator cuff cable tears in a cadaveric shoulder model. J Bone Joint Surg Am 95(20):1817–1824

    Article  PubMed  Google Scholar 

  22. Miller BS, Downie BK, Kohen RB, Kijek T, Lesniak B, Jacobson JA, Hughes RE, Carpenter JE (2011) When do rotator cuff repairs fail? Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears. Am J Sports Med 39(10):2064–2070

    Article  PubMed  Google Scholar 

  23. Nho SJ, Ghodadra N, Provencher MT, Reiff S, Romeo AA (2009) Anatomic reduction and next-generation fixation constructs for arthroscopic repair of crescent, L-shaped, and U-shaped rotator cuff tears. Arthroscopy 25(5):553–559

    Article  PubMed  Google Scholar 

  24. Park MC, Detoc E, Lee TQ (2022) Anterior cable reconstruction: prioritize rotator cable and tendon cord when considering superior capsular reconstruction. Arthroscopy 38(5):1705–1713

    Article  PubMed  Google Scholar 

  25. Park MC, Hung VT, DeGiacomo AF, McGarry MH, Adamson GJ, Lee TQ (2021) Anterior cable reconstruction of the superior capsule using semitendinosus allograft for large rotator cuff defects limits superior migration and subacromial contact without inhibiting range of motion: a biomechanical analysis. Arthroscopy 37(5):1400–1410

    Article  PubMed  Google Scholar 

  26. Park MC, Itami Y, Lin CC, Kantor A, McGarry MH, Park CJ, Lee TQ (2018) Anterior cable reconstruction using the proximal biceps tendon for large rotator cuff defects limits superior migration and subacromial contact without inhibiting range of motion: a biomechanical analysis. Arthroscopy 34(9):2590–2600

    Article  PubMed  Google Scholar 

  27. Sallay PI, Hunker PJ, Lim JK (2007) Frequency of various tear patterns in full-thickness tears of the rotator cuff. Arthroscopy 23(10):1052–1059

    Article  PubMed  Google Scholar 

  28. Seo JB, Kwak KY, Park B, Yoo JS (2021) Anterior cable reconstruction using the proximal biceps tendon for reinforcement of arthroscopic rotator cuff repair prevent retear and increase acromiohumeral distance. J Orthop 23:246–249

    Article  PubMed  PubMed Central  Google Scholar 

  29. Shin SJ, Kim IW, Park I, Lee S, Kim MS (2021) Anterior cable reconstruction using the biceps tendon in retracted anterior L-shaped rotator cuff tears. Arthrosc Tech 10(1):e55–e60

    Article  PubMed  Google Scholar 

  30. Takeda Y, Fujii K, Suzue N, Miyatake K, Kawasaki Y, Yokoyama K (2021) Repair tension during arthroscopic rotator cuff repair is correlated with preoperative tendon retraction and postoperative rotator cuff integrity. Arthroscopy 37(9):2735–2742

    Article  PubMed  Google Scholar 

  31. Uno T, Mura N, Yuki I, Oishi R, Takagi M (2022) Factors correlated with the optimal tension for arthroscopic rotator cuff repair using grasper tensioning attachment. J Shoulder Elbow Surg 31(5):e213–e222

    Article  PubMed  Google Scholar 

  32. Yamakado K (2019) A prospective randomized trial comparing suture bridge and medially based single-row rotator cuff repair in medium-sized supraspinatus tears. Arthroscopy 35(10):2803–2813

    Article  PubMed  Google Scholar 

  33. Yoon TH, Kim SJ, Choi YR, Shin JC, Alruwaili SH, Chun YM (2021) Anterior rotator cable disruption does not affect outcomes in rotator cuff tear with subscapularis involvement. Knee Surg Sports Traumatol Arthrosc 29(1):154–161

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea

    Hyunchul Yang & Sang-Jin Shin

  2. Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Republic of Korea

    Sanghyeon Lee

Authors
  1. Hyunchul Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanghyeon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sang-Jin Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HY participated in the drafted the manuscript and performed the statistical analysis. SL participated in the design of the study and analysis of radiographic data. SJS conceived of the study and participated in its design and carried out final manuscript. The manuscript has been read and approved by all authors and each author believes that the manuscript represents honest work. No duplicate submission or publication elsewhere of any part of the work.

Corresponding author

Correspondence to Sang-Jin Shin.

Ethics declarations

Conflict of interest

None.

Ethical approval

The Institutional Review Board of Ewha Womans University Seoul Hospital approved this study (IRB no: EUMCS 2021-06-018).

Informed consent

Informed consent was obtained from all participants included in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, H., Lee, S. & Shin, SJ. Satisfactory functional and structural outcomes of anterior cable reconstruction using the proximal biceps tendon for large retracted rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 31, 1910–1918 (2023). https://doi.org/10.1007/s00167-022-07112-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-07112-1

Keywords

Search

Navigation