Combined autogenous fascia lata graft bridging with biceps transposition versus partial repair for massive rotator cuff tears: a retrospective comparative study.

Abstract

Graft bridging (GB) and long head of the biceps tendon (LHBT)-based reconstructive techniques have been used to manage massive rotator cuff tears (MRCTs); however, their clinical outcomes remain variable. In this study, we explored a combined strategy of autogenous fascia lata graft bridging with LHBT transposition. The aim was to compare the effectiveness of this combined approach with partial repair in the treatment of MRCTs. This retrospective comparative study evaluated two surgical treatments for MRCTs (> 5 cm or ≥ 2 tendons involved, Hamada grade 1-3): partial repair (the partial repair group) versus autogenous fascia lata graft bridging combined with LHBT transposition (the combined surgery group). Patients were enrolled between January 2016 and June 2023. The clinical outcomes included active range of motion (forward flexion, external rotation, internal rotation) and the American Shoulder and Elbow Surgeons (ASES) score and the Constant Murley Score (CMS) assessed before surgery and at the final follow-up (≥ 2 years). Radiographic assessments were used to determine the acromiohumeral interval (AHI) and graft integrity before surgery and at the final follow-up. The study enrolled 53 patients with MRCTs, of whom 24 underwent partial repair and 29 received autogenous fascia lata graft bridging with LHBT transposition. Both groups demonstrated significantly improved ASES and CMS scores at the final follow-up (≥ 2 years), with superior outcomes in the combined surgery group (ASES: 88.6 vs. 84.0, P = 0.014; CMS: 83.4 vs. 77.4, P < 0.001). While both groups showed comparable improvements in the range of motion (both P < 0.001), the combined surgery group exhibited significantly greater restoration of AHI (7.4 mm vs. 5.4 mm, P < 0.001). MRI assessment revealed significantly lower retear rates (6.9% vs. 37.5%, P = 0.015) in the combined surgery group. This study suggests that an augmented reconstruction strategy combining autogenous fascia lata graft bridging and LHBT transposition provided better ASES and CMS scores, increased acromiohumeral distance, and lower retear rates compared with partial repair alone at two-year follow-up.