Two-Year Outcomes of Non-Conservative Treatment of the Long Head of the Biceps Tendon in the Repair of Small Supraspinatus Tears: A Multicenter Prospective Study.

Introduction: The management of the long head of the biceps tendon (LHBT) is well established in case of massive, irreparable rotator cuff tears (RCTs). However, its treatment in the context of small RCTs, especially those involving the supraspinatus tendon remain controversial, with ongoing debate over whether tenotomy, tenodesis, or simple preservation is the most appropriate approach. This study hypothesized that a non-conservative treatment (either isolated tenotomy or tenodesis) would yield equivalent functional outcomes, regardless of the macroscopic intraoperative appearance of the biceps tendon.

Materials and methods: In this prospective multicenter study, 210 patients underwent rotator cuff repair for a tear primarily affecting the supraspinatus tendon. A tenotomy or a tenodesis of the LHBT was systematically performed, regardless of its intraoperative appearance (normal or pathologic). Functional outcomes at two years (VAS, Constant score, SSV, ASES score) were collected and compared according to the macroscopic aspect of the tendon. To account for potential confounding factors, a 1:1 propensity score matching was performed. Outcomes were also compared between tenotomy and tenodesis groups. Cuff healing was assessed by ultrasound at the last follow-up.

Results: At the two-year follow-up, after propensity-score matching, no statistically significant differences were found between groups in any of the tested score (Constant score, p =  0.96; VAS, p =  0.33; ASES score, p =  0.50). Before matching, functional scores were significantly better in patients who underwent tenotomy or tenodesis in combination with cuff repair when the LHBT appeared macroscopically normal during surgery: Constant score (87 ± 8 vs. 83 ± 11, p = 0.003), ASES score (91 ± 19 vs. 85 ± 22, p = 0.002), and SSV (95 ± 9 vs. 79 ± 31, p < 0.001). No statistically significant difference was found in Constant score improvement. Tenodesis was associated with better flexion strength, but no statistical differences were observed for other outcomes, including the Popeye deformity. At two years, cuff healing rates were similar between the two groups.

Conclusion: After controlling for confounding factors, the macroscopic appearance of the LHBT did not significantly influence clinical outcomes at two years after rotator cuff repair and tenotomy or tenodesis.

Level of evidence: III; Prospective non-randomized study.