Biceps augmentation to improve the footprint coverage and functional outcomes in the treatment of large to massive rotator cuff tears

BACKGROUND: The biceps tendon can be used as an option for augmentation in large to massive rotator cuff (RC) tears, although no definitive recommendations can be given. The purpose of the study was to compare the functional outcomes of arthroscopic RC partial repair with biceps augmentation with RC partial repair alone in treatment of large to massive tears. METHODS: A retrospective review of 175 patients with large to massive RC tears was conducted, and 45 patients who underwent RC partial repair with biceps augmentation were finally included. One or two margin convergences with the biceps tendon were performed to reduce the tear gap, and torn RC was repaired to its original footprint using a combination of RC tendons and biceps tendon. Patients treated with the RC partial repair with biceps augmentation were placed in the biceps cohort and were age- and sex-matched 1:1 with a second cohort treated with RC partial repair alone, referred to as the partial cohort. We defined acceptable footprint coverage as complete coverage of the humeral head with a small residual footprint defect remaining after surgery. All patients were evaluated preoperatively and were followed up with a visual analog scale for pain, Constant score, radiographs, and ultrasonography at a minimum of 24 months. RESULTS: A total of 45 patients were included in the biceps cohort and 45 in the partial cohort. There were statistical differences in acceptable footprint coverage (34 vs. 15 cases, p = .01), average acromiohumeral interval at the final follow-up (8.6 vs. 7.5 mm, p = .02), average Constant scores at the final follow-up (79.8 vs. 75.2 points, p = .03), and ultrasonographic findings of partial-to-intact healing (38 vs. 17 cases, p = .01) between the two cohorts. Overall satisfactory outcomes were achieved in most patients regardless of biceps augmentation, the Constant scores of biceps cohort were significantly higher at final follow-up. CONCLUSIONS: Arthroscopic RC partial repair with biceps augmentation was associated with increased acromiohumeral interval and better functional outcomes compared with RC partial repair alone, and improved footprint coverage might affect the outcomes. STUDY DESIGN: Prognostic, cohort study, therapeutic Level III.