Long head of the biceps tendon patch augmentation improves external rotation after reverse shoulder arthroplasty

Reverse shoulder arthroplasty (rTSA) reliably restores active elevation but often results in limited improvements in external rotation. Although tendon transfer procedures have been used to address this limitation, they need additional surgical exposure and may increase surgical invasiveness. Therefore, less invasive strategies to improve external rotation after rTSA are necessary. This study evaluated the clinical outcomes of adjunctive rotator cuff reconstruction strategies combined with over-the-top subscapularis repair (OTTR) during rTSA.

This retrospective study included 57 patients who underwent rTSA with a minimum follow-up of 12 months. The patients were categorized into 3 groups according to surgical procedure: OTTR alone (n = 10), OTTR combined with posterior rotator cuff repair (OTTR-RCR; n = 36), and OTTR combined with long head of the biceps tendon (LHB) patch augmentation (OTTR-LHB; n = 11). Clinical outcomes were assessed using range of motion (ROM), the Japanese Orthopaedic Association score, the Constant Murley score, and the University of California, Los Angeles score. Changes in the ROM (ΔROM) were compared among the groups.

Flexion, abduction, and all clinical outcome scores improved significantly in all groups. Internal rotation improved significantly in the OTTR-RCR group, whereas external rotation improved significantly only in the OTTR-LHB group. The mean improvement in external rotation differed significantly among the groups (P = .01), with the OTTR-LHB group demonstrating a significantly greater improvement than both the OTTR-alone and OTTR-RCR groups.

Adjunctive soft tissue reconstruction during rTSA may help address persistent deficits in external rotation. In particular, LHB patch augmentation provided meaningful improvement in external rotation without compromising internal rotation and may represent a less invasive alternative to tendon transfer procedures in selected patients.