Background: Massive rotator cuff tears (RCTs) often lead to superior migration and poor function. While superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT) autograft is a promising technique, the optimal management of its distal portion (tenotomy vs. retention) remains unclear.
Objective: To compare the clinical outcomes of SCR by a long head of the biceps tendon (LHBT) autograft with biceps tenotomy or not in massive RCTs.
Methods: In this retrospective cohort study, we enrolled and followed 59 patients following SCR using the LHBT between 2016 and 2021. Patients were divided into two groups based on intraoperative management of the distal LHBT: the LHBT-retained group and the LHBT-tenotomy group. Statistical comparisons included repeated-measures ANOVA, two-way mixed-design ANOVA, chi-square/Fisher's exact tests, and Mann–Whitney U tests as appropriate. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, constant score and range of motion (ROM), and the acromiohumeral distance (AHD) were assessed as outcome measures.
Results: No major surgical complications were observed in any patient after surgery. The VAS score (7.0 vs. 0.6), AHD (3.2 ± 1.1 vs. 7.8 ± 0.8 mm), ASES (38 vs. 92), constant score (41 vs. 80), and ROM were statistically improved compared to their preoperative values. All patients were further subdivided into two groups according to the management of the distal end of the LHBT after transposition and fixation (retained group: the distal part of the LHBT was retained; tenotomy group: the distal part of the LHBT was resected). The two groups had comparable baseline demographic and clinical characteristics. We found that tenotomy group showed more significant function improvement within 12 months postoperatively (p < 0.05) compared with retained group. Nevertheless, compared with tenotomy group, the AHD of retsained group increased by 1.9 mm (5.0 ± 1.2 mm vs. 3.1 ± 0.8mm). Postoperative imaging assessment at 2 years revealed low and comparable retear rates (grades IV–V) between groups (retained group: 9.7% vs. tenotomy group: 7.1%).
Conclusion: SCR using the LHBT autograft significantly improves outcomes in massive RCTs. While both techniques are effective, patients with distal biceps tenotomy (tenotomy group) exhibited superior early functional recovery (within 12 months), whereas those with an intact distal LHBT (retained group) demonstrated significantly greater improvement in AHD. Both groups achieved comparably low retear rates.
Level of Evidence: Level 4.
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2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
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