Preservation of the long head of the biceps tendon is a viable option in rotator cuff repair: a retrospective comparative study using Biceps Inflammation Section Integrity classification

Background: The long head of the biceps tendon (LHBT) is a major contributor to shoulder pain in patients with rotator cuff tears (RCT), which is why tenotomy or tenodesis is commonly performed during RCT surgical repair. However, recent evidence highlights the importance of preserving the LHBT due to its potential role as an augmentative structure and stabilizer. Currently, no clear consensus or objective criteria exist to guide decisions about whether the LHBT should be sacrificed or preserved during rotator cuff repair. In this study, we compare clinical outcomes among patients with similar degrees of LHBT degeneration who were treated either with tenotomy (±tenodesis) or with debridement and radiofrequency ablation. Methods: We performed a retrospective comparative study. Group I was composed of 75 patients (mean age, 64.90±4.60; female, 46; male, 29) with large RCTs who underwent arthroscopic cuff repair associated with LHBT debridement and radiofrequency ablation for a Biceps Inflammation Section Integrity (BISI) score <5. Group II was composed of 86 patients (mean age, 65.70±3.58; female, 48; male, 38) with large RCTs who underwent arthroscopic cuff repair associated with LHBT tenotomy/tenodesis for a BISI score <5. All RC repairs were performed using a single-row technique with titanium anchors. Clinical outcomes were evaluated 1 year postoperatively using the Constant-Murley Score, the visual analog scale (VAS) for pain, and patient satisfaction surveys. Group comparisons were conducted using standard tests for continuous and categorical variables. Results: At the 1-year follow-up, the mean Constant scores were 76 in the preservation group and 78 in the tenotomy group, with no statistically significant difference (P=0.16). Both groups reported low pain levels (mean VAS, 2). Similar strength deficits and partial limitations in shoulder rotations were observed in both groups. Patient satisfaction rates were 79% vs 81%, respectively. Conclusions: Routine sacrifice of the LHBT during rotator cuff repair may not be necessary for mild to moderate degeneration (BISI <5). Biceps preservation may help maintain shoulder biomechanics and offer advantages for future revision surgeries. Level of evidence: III.