Preoperative predictors of graft retear following arthroscopic superior capsule reconstruction with long head of biceps tendon autograft: a pilot retrospective case-control study.

BACKGROUND

Superior capsule reconstruction (SCR) using the long head of the biceps tendon (LHBT) is a joint-preserving option for large-to-massive rotator cuff tears, but predictors of graft retear remain incompletely characterized. We aimed to identify preoperative clinical and imaging predictors of retear after arthroscopic LHBT-SCR.

METHODS

A retrospective pilot case-control study was conducted at two tertiary orthopedic centers. Cases had confirmed graft retear (Sugaya type IV-V on postoperative magnetic resonance imaging); controls had an intact graft and were sampled at an approximate 2:1 ratio. Forty patients were included and followed for a median of 24 months (range, 12-26 months). Preoperative variables included age, sex, tear dimensions, Hamada grade, Goutallier grade, and functional scores (Constant-Murley, American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA]). A forced-entry multivariable logistic model with three predictors was fitted; thresholds were derived using the Youden index.

RESULTS

Fourteen cases and 26 controls were identified. Preoperative Constant-Murley (median, 23.1 vs. 35.1; P=0.014), ASES (25.8 vs. 35.0; P=0.020), and UCLA (9.0 vs. 11.0; P=0.021) scores were lower in the retear group. Tear morphology did not differ between groups. The multivariable model (ASES, Goutallier grade, forward elevation; complete-case n=38) achieved an apparent area under the curve (AUC) of 0.811 (bootstrap optimism-corrected AUC, 0.754). Despite structural failure, both groups achieved equivalent functional recovery, with all patients exceeding their minimal clinically important differences.

CONCLUSIONS

Preoperative functional impairment was the primary correlate of graft retear after LHBT-SCR. Prospective validation in a larger case-control study (target n=132) is warranted. Level of evidence: IV.