Outcomes of suture bridge repair reinforced using a biceps rerouting technique

Many techniques are available for arthroscopic rotator cuff repair, and autografts or allografts can be used in cases of poor tendon quality or large size tears. The long head of the biceps tendon is a good material for autografts. Rerouting of the biceps long head tendon during arthroscopic rotator cuff repair is a good option when repair is otherwise difficult. We analyzed the clinical results and retear rates over 2 years of follow-up after rotator cuff suture bridge repair reinforced using the biceps rerouting technique in patients with large rotator cuff tears.

We retrospectively studied 56 patients who underwent arthroscopic rotator cuff suture bridge repair reinforced via biceps rerouting between June 2018 and December 2021 at our clinic and were followed up for a minimum of 2 years after surgery. Pain and shoulder joint function were evaluated using the visual analog scale and American Shoulder and Elbow Surgeons scale before and after surgery, respectively. Outpatient ultrasound examinations were performed at 6, 10, and 14 weeks and at the 6-, 12-, and 24-month follow-up visits to explore the retear status. The paired t-test and Wilcoxon signed-rank test were used for statistical analyses.

The average visual analog scale score decreased from 5.32 ± 2.36 to 2.57 ± 1.93 during the 2 years of follow-up (P < .001), and the American Shoulder and Elbow Surgeons scale score increased from 51.34 ± 18.44 to 72.62 ± 18.81 (P < .001). In terms of range of motion, significant increases were observed in forward flexion (113-135), external rotation (abduction 0°) (29-39), and external rotation (abduction 90°) (30-56), but not in internal rotation (P = .635) (6-6) at 24 months postoperatively. Six patients (10%) developed bicep tendon ruptures, but these did not increase pain or affect the range of motion. Five patients (9%) exhibited rotator cuff retears, of which 2 were partial and 3 were complete. Partial retears in both patients were accompanied by humeral neck fractures attributable to slipping. The 3 complete retears occurred within 4 months after surgery, all during self-selected laborious activities rather during rehabilitation exercises.

The retear rate of suture bridge repair reinforced using biceps rerouting in large rotator cuff tears is 9%, and this technique affords clinically significant improvement.