Combined subscapularis and supraspinatus tears markedly increase the risk of long head of the biceps tendon pathology

Objective: This study aimed to examine the frequency of long head of the biceps tendon (LHBT) pathologies in anterosuperior rotator cuff tears (RCT) involving the LHBT pulley system and investigate the relationship between RCT types and LHBT pathology subtypes.Methods: A retrospective review was conducted of 555 shoulder arthroscopies performed for rotator cuff tears between 2017 and 2023. Patients were classified into 3 groups: isolated subscapularis (SSC) tears (n=74), isolated supraspinatus (SSP) tears (n=177), and combined SSC+SSP tears (n=304). The severity of the subscapularis tear was graded using the Lafosse classification. The LHBT pathologies were categorized as tendinitis, subluxation, dislocation, partial rupture, and full-thickness rupture.Results: The LHBT pathology was present in 86.1% of cases. The most common pathologies were tendinitis (44.7%), complete rupture (13.5%), partial rupture (12.1%), subluxation (8.5%), and dislocation (7.4%). The SSC+SSP group had the highest LHBT pathology rate (99.0%) compared to isolated SSC (70.3%) and SSP (70.6%) groups (P < .001). The SSC+SSP group had a 36.04 times higher risk of LHBT pathology than the SSP group (P < .001). Dislocation and complete rupture were most frequent in the SSC+SSP group (P < .001). The LHBT pathology prevalence increased with Lafosse grade (P < .001), and higher grades were strongly associated with dislocation and rupture.Conclusion: Anterosuperior rotator cuff tears are strongly associated with LHBT pathologies, and the severity of LHBT pathologies increases in parallel with the Lafosse grade. Combined SSC+SSP tears significantly increase the risk of LHBT pathology, particularly dislocation and complete rupture, highlighting the need for thorough LHBT evaluation in anterosuperior RCT cases.Level of Evidence: Level III, Prognostic Study.Cite this article as: Kaya I, Yaş S, Bircan R, Ahmadov A, Sarikaya B, Kanatli U. Combined subscapularis and supraspinatus tears markedly increase the risk of long head of the biceps tendon pathology. Acta Orthop Traumatol Turc., 2026, 60(2), 0483, doi: 10.5152/j.aott.2026.25483.