Novel Approaches in Rotator Cuff Repair: A Closer Look at Triple-Row and Biceps Tendon Augmentation

According to recent research, the side-to-side triple-row repair produced meaningful short-term gains in shoulder range of motion and validated clinical scores for patients with massive rotator cuff tears — offering predictable early functional improvement but with a substantial retear risk that should inform recovery planning.

Thirty-four consecutive procedures were included in the short-term case series (mean follow-up 23.8 months) using a blended prospective inclusion and retrospective outcome review. The repair combined a triple-row stitch pattern to restore footprint contact and distribute load with autologous augmentation using the long head of the biceps. Unlike single-row repairs (one fixation line) or double-row repairs (medial and lateral fixation lines), the triple-row construct spreads tensile loads across three fixation planes and compresses tendon more uniformly against the footprint, which plausibly explains earlier measurable gains in range of motion while structural vulnerability persists during healing.

Objective outcomes showed statistically significant improvements from baseline across shoulder ROM, the American Shoulder and Elbow Surgeons (ASES) score, and the Constant–Murley (CM) score (all p<0.001), indicating clinically meaningful pain and function benefits at short-term follow-up. The operative strategy included biceps tendon augmentation to bolster the repair scaffold and potentially improve early load transfer. Most patients achieved notable mean improvements by final follow-up, but subgroup analysis showed smaller gains in ROM and clinical scores among patients who later sustained a tendon retear versus those with intact repairs.

Complications were explicit: 10 of 34 patients (29.4%) had a postoperative retear on imaging at least one year after surgery. Reteared repairs were associated with significantly lower ROM (except internal rotation), poorer clinical scores (p<0.01 versus healed repairs), and higher degrees of supraspinatus fatty infiltration both before and after surgery. Rehabilitation implications therefore include more cautious early loading, consideration of a staged or slower strengthening progression for higher-risk profiles, and targeted surveillance imaging when functional gains plateau. The central recovery challenge is balancing the early functional restoration this construct enables against a nearly one-third retear risk that undermines longer-term stability.

Integrating the data, the triple-row construct with autologous biceps augmentation yields meaningful early functional improvement but carries a nontrivial structural-failure signal that should influence case selection, preoperative counseling, and perioperative planning.