Clinical outcomes of long head of the biceps tendon augmentation versus partial repair in massive rotator cuff tears

OBJECTIVE: To compare the clinical outcomes of rotator cuff repair augmented with the long head of the biceps tendon (LHBT) and partial repair (PR) in patients with massive rotator cuff tears (RCTs). METHODS: This retrospective study included patients who underwent arthroscopic surgery for massive RCTs between January 2020 and May 2024. Forty-six patients were treated with rotator cuff repair augmented using the LHBT (LHBT group), and 49 patients underwent PR (PR group). Clinical outcomes were assessed using the Constant-Murley (CM), American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) scores, visual analog scale (VAS) for pain, and shoulder range of motion (ROM). Postoperative magnetic resonance imaging was performed selectively in patients without satisfactory clinical improvement. RESULTS: Both groups demonstrated statistically significant postoperative improvement in all clinical and functional parameters (p < 0.001). However, the LHBT group showed superior postoperative clinical outcomes compared with the PR group. Re-rupture requiring reoperation occurred in 3 patients in the LHBT group and in 11 patients in the PR group. Proximal LHBT rupture was observed in 1 patient. Increasing grades of fatty degeneration were associated with significantly worse postoperative clinical scores and ROM in both groups. CONCLUSION: LHBT augmentation is a successful technique for the treatment of massive retracted RCTs and provides superior clinical outcomes compared with PR. PR remains a viable option in carefully selected patients when LHBT augmentation is not feasible.