Both Rerouted and In Situ Biceps Superior Capsular Reconstruction Augmentation During Arthroscopic Rotator Cuff Repair Improve Clinical Outcomes

Purpose To evaluate the clinical and radiologic outcomes at a 2‐year follow‐up of arthroscopic rotator cuff repair (RCR) augmented with superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT) in patients with reparable posterosuperior rotator cuff tears. Methods This retrospective, multicenter study included patients who underwent arthroscopic RCR with LHBT‐based SCR at 2 institutions: Center A (October 2020 to March 2023) and Center B (June 2022 to July 2024), with a follow‐up of 2 years. Indications included reparable supraspinatus and/or infraspinatus tears with Patte stage 2‐3 retraction and Goutallier grade 3‐4 fatty infiltration. Patients underwent RCR with either in situ LHBT fixation (Center A) or rerouted LHBT fixation to the center of the greater tuberosity (Center B). Exclusion criteria included prior shoulder surgery, infection, irreparable subscapularis tear, or loss to follow‐up. Clinical outcomes were assessed using the visual analog scale, American Shoulder and Elbow Surgeons score, and range of motion. Radiologic evaluation included acromiohumeral distance, Hamada grade, and repair integrity via ultrasound or magnetic resonance imaging. Results After excluding 10 patients, 58 were included (N = 26, Center A; N = 32, Center B), and their 2‐year clinical outcomes were compared. Visual analog scale improved from 5.9 ± 1.5 to 2.1 ± 1.3, and American Shoulder and Elbow Surgeons score from 41.2 ± 10.0 to 73.6 ± 12.7 ( P < .001). Minimal clinically important difference was achieved in 96.5% (visual analog scale) and 94.8% (American Shoulder and Elbow Surgeons). Range of motion improved significantly in forward elevation, abduction, and external rotation. Acromiohumeral distance (increased from 8.1 to 9.0 mm P < .001) with no progression in Hamada grade. Both centers showed comparable improvements with no significant differences in outcomes between techniques. Conclusions Arthroscopic RCR augmented with SCR using the LHBT resulted in significant improvements in pain, function, and range of motion at the 2‐year follow‐up in patients with reparable rotator cuff tears. Both in situ and rerouted LHBT‐based SCR techniques produced comparable clinical and structural outcomes, with no significant differences observed between the 2 methods, with the potential for type II error due to low power. Level of Evidences Level III, retrospective comparative case series.