Summary

To evaluate outcomes of this novel technique of anterior rotator cable reconstruction using the long head of biceps (LHB) tendon in massive rotator cuff tears.

Abstract

Background

Massive rotator cuff tears are challenging, with primary repair limited by tissue quality and retraction. Additionally, these tears typically compromise the anterior rotator cable, which is vital in shoulder biomechanics. This bundle of fibers near the superior cuff insertion protects the aponeurotic rotator crescent and transfers stress to the greater tuberosity. Disruption of the cable is associated with increased tear propagation, tendon strain, muscle atrophy, and accelerated tendon retraction. Therefore, cable restoration offers great potential. This technique of anterior cable reconstruction has not been described.

Methods

This prospective, cohort analysis evaluates outcomes after a novel anterior rotator cable reconstruction performed by a single surgeon. Qualifying patients demonstrated an intact LHB tendon, with reparable massive cuff tear involving anterior cable. The surgical technique utilizes LHB to reconstruct the anterior cable and augment the repair of remaining rotator cuff to the greater tuberosity. All patients were followed for minimum 12 months with outcome measures including Visual Analog Scale (VAS), PROMIS (NIH), and ASES.

Results

Data was reviewed for 23 patients. Variation in age, BMI, and medical comorbidities was insignificant. Mean VAS at 1-year follow-up: 1.7, improved from pre-op by 5.0 (p<0.01). Average PROMIS scores at 1 year: Function 46.0, Pain Inhibition 52.9, Mood 44.9. Improvements in PROMIS score from pre-op: Function +7.0 [(-14,+25), p<0.01], Pain -10.3 [(-2,+7), p<0.01], Mood -4.9 [(-19,+16), p=0.02]. ASES score at 1-year: mean improvement of 40 points.

Conclusions

The anatomic and biomechanical value of the rotator cable is apparent. Anterior cable reconstruction using LHB tendon autograft significantly improves outcomes in patients with massive cuff tears. Further prospective study should evaluate biomechanical and clinical superiority of this novel technique to simple repair of the rotator cuff tendon.