Effects Of Biceps Transposition Without Tenotomy For Augmentation Of Massive Rotator Cuff Repairs On Function, Quality Of Life, And Sleep: A Prospective Study

Detailed Description Massive rotator cuff tears may not be amenable to full anatomic repair, and even when partial repair is feasible, residual symptoms and functional limitations may persist. Long head of the biceps tendon (LHBT) transposition without tenotomy has been proposed as an augmentation strategy that may provide additional biomechanical and biologic support to arthroscopic partial rotator cuff repair. However, prospective data with standardized follow-up evaluating functional outcomes, rotator cuff-specific quality of life, and sleep outcomes remain limited. This study is designed to generate prospective, standardized clinical and patient-reported outcome data after tenotomy-sparing LHBT transposition augmentation in the setting of massive rotator cuff repair.

This is a prospective, single-arm, non-randomized interventional clinical study conducted at Balikesir City Hospital, Department of Orthopedics and Traumatology (Balikesir, Turkiye). Consecutive eligible adult patients will be enrolled between January 2026 and December 2026, with a planned sample size of 35 participants. Each participant will be followed for a minimum of 12 months. Assessments will be performed preoperatively (baseline) and postoperatively at 3 months and 12 months.

Participants and Eligibility Massive rotator cuff tear will be defined on preoperative MRI as a full-thickness tear involving at least two tendons and/or a tear with the greatest dimension greater than 5 cm. Final eligibility will be confirmed intraoperatively when the tear pattern is deemed suitable for arthroscopic partial repair with LHBT augmentation. Inclusion criteria include age 18 years or older, persistence of symptoms despite at least 3 months of standard nonoperative treatment, planned arthroscopic partial repair with LHBT augmentation, intact LHBT at the time of surgery, and willingness to attend the scheduled follow-up visits. Exclusion criteria include tear patterns not requiring augmentation (e.g., preserved rotator cable patterns), conditions affecting shoulder function (e.g., relevant neurologic disease, inflammatory arthritis), active infection, systemic conditions preventing protocol rehabilitation, inability to provide informed consent, or expected nonadherence to follow-up.

Intervention and Standardization All surgeries will be performed arthroscopically under general anesthesia (with or without interscalene block per anesthesia protocol) in the beach-chair position. Standard diagnostic glenohumeral assessment and subacromial bursectomy will be performed. Acromioplasty may be performed routinely per the surgical standard. The rotator cuff will be mobilized and partially repaired to achieve acceptable tension. For augmentation, the LHBT will be confirmed intact and will not be tenotomized. The transverse humeral ligament will be released to mobilize the tendon. The tendon will be transposed posterior to the bicipital groove and directed to the superior aspect of the greater tuberosity, avoiding overtension. Fixation will be performed to the footprint region using a standardized anchor/suture technique to create an augmentation construct supporting the partial repair. Arthroscopic assessment will confirm absence of overtension and mechanical impingement. Concomitant procedures (e.g., subscapularis repair, distal clavicle resection) will be performed only when clinically indicated and will be recorded.

Rehabilitation Protocol Postoperative management will be standardized: sling immobilization for 3 weeks; passive range of motion initiated immediately in the early postoperative period within pain limits; active range of motion starting at postoperative week 4; strengthening at approximately postoperative month 3. Biceps loading will be restricted for the first 4 weeks (no resisted elbow flexion or supination), followed by gradual progression. Rehabilitation adherence and protocol deviations will be documented.