Abstract
BACKGROUND: Biceps autograft augmentation, performed by incorporating the long head of the biceps tendon into the rotator cuff repair construct, aims to leverage the biceps tendon tissue for collagen augmentation and biomechanical properties. Prior studies have demonstrated effectiveness of augmentation of rotator cuff tears using autologous biceps tendon transfer. We present a biceps augmentation technique that involves a subpectoral tenodesis proximal to the myotendinous junction while preserving the proximal long head of the biceps tendon origin on the supraglenoid tubercle. This case series aimed to assess the clinical, functional, and patient-reported outcomes following this novel surgical approach for rotator cuff repair. METHODS: A retrospective review was performed of patients who underwent a subpectoral biceps tenodesis and transfer by a single fellowship-trained shoulder and elbow surgeon to augment large rotator cuff tears. Preoperative and postoperative chart review was conducted to compare shoulder flexion and abduction range of motion, as well as visual analog scale shoulder pain scores. At the final follow-up, an average of 19.6 ± 5.6 months postoperative, data were collected on any reported biceps pain or cosmetic deformity, the American Shoulder and Elbow Surgeons (ASES) score, and the Single Assessment Numeric Evaluation (SANE) score. RESULTS: Thirty-one patients (mean age 65.7 ± 9.7 years, male-to-female ratio 1.6:1, average body mass index 29.7 ± 5.5 kg/m(2)) were included in the study. The right shoulder was affected in 64.5% of patients, and 58% reported a traumatic cause for their rotator cuff tear. Tears were present in both the supraspinatus and infraspinatus tendons in 61% of patients. Postoperatively, visual analog scale pain scores decreased from 6.7 ± 2.2 preoperatively to 0. Shoulder flexion improved from 96.8 ± 56.1° to 152.9 ± 25.9° (P = .0006), and abduction from 77.6 ± 39.7° to 123.4 ± 47° (P = .0001). External rotation showed no significant change (P = .2). The mean postoperative ASES score was 95.5 ± 3.8, and the SANE score was 82.2 ± 11.8. Two patients (6.5%) reported intermittent biceps pain during supination, but there were no serious complications, rotator cuff retears, or cosmetic deformities observed during the observation period. DISCUSSION: A subpectoral biceps tenodesis and transfer technique in rotator cuff repairs demonstrates low rates of postoperative biceps pain and marked increases in shoulder range of motion. Improvements in patient-reported outcome scores (ASES, SANE), coupled with the absence of biceps-related symptoms in all but 2 patients, support the early efficacy of this novel surgical technique in managing rotator cuff tears.