Combined Autogenous Fascia Lata Graft Bridging with Biceps Transposition Versus Partial Repair for Massive Rotator Cuff Tears: A Retrospective Comparative Study

Background : Graft bridging (GB) and superior capsular reconstruction (SCR) are utilized to treat massive rotator cuff tears (MRCTs), however they all have reported mixed results. In this study, we explore to combine the GB and SCR in one surgery. The aim of this study was to compare the effectiveness of surgeries that combing GB and SCR (in which autogenous fascia lata is used as the graft for GB while the long head of the biceps tendon [LHBT] is transposed for SCR) with partial repair in the treatment of MRCTs. Methods : This retrospective comparative study evaluated two surgical treatments for MRCTs (> 5 cm, ≥ 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 at before surgery and at the final follow-up. Results : 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. Conclusion : This study suggests that autogenous fascia lata graft bridging combined with biceps transposition is associated with better ASES and CMS scores, increased acromiohumeral distance, and lower retear rates compared with partial repair alone at two-year follow-up.