Functional recovery after rotator cuffrepair: the role of biceps surgery

Context: Surgical cuff repair is recommended in a full-thickness rotator cuff tear when nonoperative treatment fails. Surgical cuff repair can include surgery of the long head of the biceps when concomitant biceps pathology is present. However, the studies executed up till now have not yet clearly defined if additional biceps surgery affects the shoulder functionality in patients who underwent rotator cuff repair. Objective: To verify if the concomitant biceps surgery prejudices shoulder functionality during the short-term period in rotator cuff repair patients. Design: Prospective and observational study. Setting: Outpatient service for rehabilitation. Patients: Ninety-three consecutive patients who had undergone surgery for full-thickness symptomatic rotator cuff tear were enrolled for rehabilitation; 25 underwent rotator cuff repair and tendon biceps surgery (ABS), while 68 underwent rotator cuff repair only (RCR). Interventions: Motor rehabilitation after surgical treatment of rotator cuff repair. Measures: Final Constant score was used as primary outcome measure, and efficiency and effectiveness in Constant score were evaluated both at the end of the last cycle of rehabilitation and 6 mo postsurgery. Results: Patients with rotator cuff repair and tendon biceps surgery had lower final scores (36.5 ± 12.0 vs 49.3 ± 13.0, P < .001), effectiveness (40.6 ± 18.0 vs 60.3 ± 20.0, P < .001), and efficiency (0.80 ± 0.5 vs 1.19 ± 0.6, P = .010) in Constant score than those with rotator cuff repair only at the end of rehabilitation. Moreover, they had a lower final score (53.3 ± 14.0 vs 64.5 ± 10.0, P < .001) and effectiveness (66.9 ± 21.0 vs 84.0 ± 16, P < .001) in Constant score 6 mo postsurgery. Gender was a determinant of final score, efficiency, and effectiveness in Constant score at the end of the rehabilitation period, while tendon biceps surgery was a determinant of final score and effectiveness in Constant score at the end of the rehabilitation period and at 6 mo postsurgery. Conclusions: This study highlights that concomitant tendon biceps surgery negatively affects functional outcome of patients who underwent rotator cuff repair and is an important determinant of shoulder functionality in the first 6 mo postsurgery.