Biceps rerouting for semi-rigid large-to-massive rotator cuff tears.

Purpose To compare clinical and radiographic results of arthroscopic rotator cuff repair (ARCR) with biceps re-routing (BR) and those of conventional repair for semi-rigid, large-to-massive rotator cuff tear (SRCT). Method We prospectively collected data of 111 patients who underwent either ARCR+BR (n=59, Group-1) or only ARCR (n=52, Group-2) for SRCT, between January 2016 and December 2018. We comparatively analyzed both groups with respect to preoperative factors including concomitant lesions of the long head of biceps tendon (LHBT). Univariate logistic regression analysis was performed to identify predictive variables for occurrence of retear after ARCR+BR. Results Mean age of group-1 and 2 was 62.8 and 63.7 years, respectively (p=0.484). Mean follow-up (F/U) period in group-1 and 2 was 15.1 and 25.1 months, respectively (p=0.102). Mean range of motion and functional scores improved significantly (p 0.05) in both groups. Totally, 11 (18.6%) and 25 (48.1%) patients from group 1 and 2, respectively, demonstrated retear of the repaired rotator cuff, at final F/U (p 50% of the LHBT, 5 (35.7%) suffered postoperative retear. If the patients had partial tear involving more than 50% of LHBT preoperatively, the odds ratio (OR) to have retear was 4.222 (p=0.037). Wider (OR:1.445, p=0.047) and thinner (OR:0.166, p=0.019) LHBT were the prognostic factors to have retear. Three (5.1%) group-1 patients demonstrated the Popeye deformity at final F/U. Conclusion ARCR+BR for semi-rigid, large-to-massive rotator cuff tears effectively improved clinical and structural outcomes as also shown in the conventional repairs. However, the retear rate was significantly lower in patients who underwent ARCR+BR, than those treated conventionally. Partial tearing involving >50% of the LHBT and wide and/or thin tendon morphology were significant risk factors for postoperative occurrence of retear. Level of Evidence Level III, Retrospective therapeutic comparative trial