Original Article

Routine long head of the biceps release improves pain and functional outcomes after arthroscopic rotator cuff repair of degenerative tears: A retrospective comparative study

¹ 2nd Department of Orthopaedic Surgery, “Konstantopouleio” General Hospital, National and Kapodistrian University of Athens, 14233 Athens, Greece
² St. Clair Health, Pittsburgh, PA, USA
³ Department of Orthopaedics, School of Medicine, University of Ioannina, Ioannina, Greece

^* Corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Received: 21 January 2026
Accepted: 26 March 2026

Abstract

Introduction: The optimal management of the long head of the biceps tendon (LHBT) during rotator cuff repair remains controversial, particularly when the tendon appears normal. This study aims to compare the clinical outcomes of arthroscopic rotator cuff repair with and without routine LHBT release. Methods: A retrospective study including patients aged >50 years with a repairable rotator cuff tear and documented normal LHBT who underwent arthroscopic surgery was conducted. Patients were divided into two groups: LHBT preservation group (n = 113) and LHBT release group (n = 110). Postoperative evaluation included the visual analog scale (VAS) for pain, while functional outcomes were assessed by the Constant-Murley score and the American Shoulder and Elbow Surgeons (ASES) scores. Postoperative pain and functional outcomes were compared between the two study groups at 12 and 24 months. Results: Groups were comparable in terms of age (p = 0.16), sex (p = 0.30), rotator cuff tear size (p = 0.51), and number of anchors used for the repair (p = 0.44). At 24 months, the LHBT release group demonstrated lower VAS score (p < 0.001), higher Constant-Murley score (medians: 86 vs 81, p < 0.001), and higher ASES score (medians: 90 vs 83, p < 0.001). Regression analysis confirmed that LHBT release is independently associated with improved functional outcomes (coefficient = 4.85, p < 0.001 for Constant-Murley score; coefficient = 6.66, p < 0.001 for ASES score). Discussion: The findings of this study indicate that routine LHBT release during rotator cuff repair, even in the absence of macroscopic pathology, is associated with less postoperative pain and superior functional scores.