Double Bridges Technique of Lower Trapezius Plus Long Head of Biceps Tendon Transfer for Superior Capsular Reconstruction in Massive Rotator Cuff Tears Can Improve the External Rotation

PURPOSE: To compare the clinical and radiological outcomes between superior capsular reconstruction (SCR) using long head of biceps tendon (LHBT) combined with arthroscopy-assisted lower trapezius transfer (LTT) and SCR using LHBT without LTT for posterosuperior irreparable massive rotator cuff tears with high fatty infiltration (Goutallier stage ≥3) of supraspinatus and infraspinatus. METHODS: Consecutive cases, undergoing SCR with or without LTT for posterosuperior irreparable massive rotator cuff tears with high fatty infiltration, from 2017 to 2022 with a minimum 2-year follow-up were retrospectively reviewed. Propensity score matching was used for age, sex, body mass index, external rotation, tear size, global fatty degeneration index, and acromiohumeral interval. Clinical outcomes, including patient-reported outcome measures (PROMs) and range of motion (ROM), and radiological outcomes, including tendon healing, acromiohumeral interval, and global fatty degeneration index, were evaluated and compared between the 2 groups. RESULTS: A total of 116 patients (63 in LTT group and 53 in SCR group) were enrolled in the study. After propensity score matching, 36 patients in each group were included in analysis. The mean follow-up period was 34.6 (24-53) months in the LTT group and 39.8 (24-77) months in SCR group. All PROMs and ROM were significantly improved in both groups, except ROM of external rotation in SCR group (19.3 ± 14.7 vs. 20.6 ± 13.9, P = .535). There were 63.9% (23 of 36) of SCR group and 69.4% (25 of 36) of LTT group exceeded minimal clinically important difference thresholds of all PROMs. There was no significant difference in function scores between the 2 groups. The postoperative external rotation was significantly better in the LTT group (35.3 ± 23.3 vs. 20.6 ± 13.9; β = 18.2, 95% confidence interval, 9.0-27.4; P < .001). Retear rate of the infraspinatus was lower in the LTT group (2 of 36 vs. 10 of 36; OR = 0.11, 95% confidence interval, 0.01-0.88; P = .021). CONCLUSIONS: SCR using the LHBT with or without LTT results in improved postoperative PROMs and ROM compared to preoperatively. However, in current analysis based on propensity score matching, combination of SCR using the LHBT with LTT shows superiority in improving external rotation and preventing infraspinatus retear for patients with high fatty infiltration. LEVEL OF EVIDENCE: Level III, retrospective cohort study.