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Koh DTS, Puah KL, Goh JKM, Tan YH, Tan ETS, Lie DTT. Raised body mass index and reduced muscle bulk reduces the incidence of Popeye's deformity post tenotomy of long head of biceps brachii. J ISAKOS 2024; 9:100293. [PMID: 39019402 DOI: 10.1016/j.jisako.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/23/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVES The development of the Popeye's deformity is a known complication of long head of the biceps tendon (LHBT) tenotomy. Incidence of developing Popeye's deformity after LHBT tenotomy ranges between 13% and 70%. While this complication is well tolerated, it can be avoided with proper patient selection. We aim to study patient and clinical factors resulting in the development of the Popeye's deformity after LHBT tenotomy so as to better identify suitable surgical candidates. METHODS 91 patients underwent unilateral rotator cuff repairs and concomitant LHBT tenotomy between March 2013 and March 2017. Assessment of patient factors contributing to Popeye's deformity included patient demographics, and physical attributes were analyzed and correlated. Patients also completed a questionnaire regarding their overall postoperative satisfaction. Prospectively collated Visual Analog Pain Scale (VAS), Constant-Murley shoulder score (CSS), University of California, Los Angeles Shoulder Score (UCLA), and Oxford Shoulder Score (OSS) were compared at 6 and 24 months post operation between patients who developed Popeye's deformity and those who did not. RESULTS The incidence of post-tenotomy Popeye's sign was 58.9%. Majority of patients were satisfied with their procedure, postoperative function, and cosmesis. Patients who developed Popeye's sign had a statistically significant lower body mass index (BMI) (24.9 ± 4.2 kg/m2 versus 27.3 ± 4.3 kg/m2, p = 0.048) (rpb = - 0.210, p > 0.05) and had a greater biceps-circumference-(in flexion)-to-wrist-circumference ratio (1.91 ± 0.16 versus 1.83 ± 0.13, p = 0.012) (rpb = 0.319, p < 0.05) than those who did not. Nevertheless, the development of Popeye's sign did not affect clinical outcomes (VAS, CSS, UCLA, and OSS; p > 0.05) at 24 months. CONCLUSIONS The incidence of Popeye's deformity is high post LHBT tenotomy. There was a greater incidence in patients with lower BMI and greater biceps brachii muscle bulk. However, this complication is well tolerated. By better selecting our patients, we can achieve better outcomes and minimize potential complications. LEVEL OF EVIDENCE Level-III evidence. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Don Thong Siang Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Building Level 4, 169856, Singapore.
| | - Ken Lee Puah
- Artisan Sports & Orthopaedic Clinic, Paragon Medical Centre, Singapore
| | - Jeremy Keng Meng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Building Level 4, 169856, Singapore
| | - Yong Hong Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Building Level 4, 169856, Singapore
| | | | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Building Level 4, 169856, Singapore
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Siddiq BS, Dean MC, Gillinov SM, Lee JS, Dowley KS, Cherian NJ, Martin SD. Biceps tenotomy vs. tenodesis: an ACS-NSQIP analysis of postoperative outcomes and utilization trends. JSES Int 2024; 8:828-836. [PMID: 39035668 PMCID: PMC11258841 DOI: 10.1016/j.jseint.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background While studies have assessed comparative rates of restoration of shoulder function and alleviation of symptoms, comparative systemic postoperative complication rates between biceps tenotomy and tenodesis have yet to be assessed. The purpose of the present study was to use a national administrative database to perform a comprehensive investigation into 30-day complication rates after biceps tenotomy versus tenodesis, thus providing valuable insights for informed decision-making by clinicians and patients regarding the optimal surgical approach for pathologies of the long head of the biceps tendon. Methods The National Surgical Quality Improvement Program database was queried to analyze postoperative complication rates and metrics associated with biceps tenotomy and tenodesis. Patient data spanning from 2012 to 2021 was extracted, with relevant variables assessed to identify and compare these two surgical approaches. Adjusted and unadjusted analyses were utilized to analyze patient demographics, comorbidities, operative times, lengths of stay, readmissions, adverse events, and yearly surgical volume, along with trends in usage, across cohorts. Results Of 11,527 total patients, 264 (2.29%), 6826 (59.22%), and 4437 (38.49%) underwent tenotomy, tenodesis with open repair, and tenodesis with arthroscopic repair, respectively. Tenotomy operative times ([mean ± SD]: 66.25 ± 44.76 minutes) were shorter than those for open tenodesis (78.83 ± 41.82) and arthroscopic tenodesis (75.98 ± 40.16). Conversely, tenotomy patients had longer hospital days (0.88 ± 4.86 days) relative to open tenodesis (.08 ± 1.55) and arthroscopic tenodesis (.12 ± 2.70). Multivariable logistic regression controlling for demographics and comorbidities demonstrated that patients undergoing tenodesis were less likely to be readmitted (adjusted odds ratio [AOR]: 0.42, 95% confidence interval [CI]: 0.17-0.98, P = .050) or sustain serious adverse events (AOR: 0.27, 95% CI: 0.13-0.57, P < .001), but equally likely to sustain minor adverse events (AOR: 0.87, CI: 0.21-3.68, P = .850), compared with patients undergoing tenotomy. Lastly, comparing utilization rates from 2012 to 2021 revealed a significant decrease in the proportion of tenotomy (from 6.2% to 1.0%) compared to open tenodesis (from 41.0% to 57.3%) and arthroscopic tenodesis (52.8% to 41.64%; P trend = .001). Conclusion To our knowledge, this is the first large national database study investigating postoperative complication rates between the various surgical treatments for pathologies of the long head of the biceps tendon. Our results suggest that tenodesis yields fewer serious adverse events and lower readmission rates than tenotomy. We also found a shorter operative time for tenotomy. These findings support the increased utilization of tenodesis relative to tenotomy in recent years.
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Affiliation(s)
- Bilal S. Siddiq
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michael C. Dean
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen M. Gillinov
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan S. Lee
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kieran S. Dowley
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Nathan J. Cherian
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, NE, USA
| | - Scott D. Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Whitaker S, Cole S, Peri M, Satalich J, O’Neill C, Vap A. Open Biceps Tenodesis and Tenotomy Have Low 30-Day Postoperative Complication Rates. Arthrosc Sports Med Rehabil 2024; 6:100928. [PMID: 39006780 PMCID: PMC11240023 DOI: 10.1016/j.asmr.2024.100928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/12/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To compare 30-day postoperative rates of adverse events, particularly infection rates, between open biceps tenodesis and biceps tenotomy. Methods The American College of Surgeons National Surgical Quality Improvement Program was filtered using Current Procedural Terminology codes to identify patients undergoing open biceps tenodesis and tenotomy from 2010 to 2021. Patients were divided into cohorts based on procedure type. Propensity score matching was used to account for confounding variables. Statistical analyses were conducted to compare 30-day postoperative outcomes between cohorts, as well as to evaluate secondary risk factors for complications. Results Overall, 12,367 patients were included in the study with 11,417 undergoing open biceps tenodesis and 950 undergoing biceps tenotomy. After matching, 1,900 patients were included in the final analysis. The rate of outpatient procedures in the tenodesis cohort was significantly higher than in the tenotomy cohort. Rates of any adverse event (AAE), sepsis, pneumonia, reoperation, and extended length of stay (LOS) were significantly higher in the tenotomy cohort compared with the tenodesis cohort. There was no difference in infection rates or wound dehiscence between the 2 groups. After multivariable analysis, increasing age, longer operative time, and history of bleeding disorders were associated with significantly higher odds of developing AAE. Conclusions In this study, we found that tenotomy and open tenodesis are both safe options for treatment of biceps pathology. The overall rate of developing AAE and the rate of postoperative sepsis were higher in the tenotomy cohort. In addition, rates of postoperative infection and wound dehiscence did not vary between the 2 groups. Small differences were additionally observed in rates of pneumonia, return to the operating room, and extended LOS, and these rates were higher in the tenotomy cohort. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Sarah Whitaker
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Sarah Cole
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Maria Peri
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - James Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, U.S.A
| | - Conor O’Neill
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, U.S.A
| | - Alexander Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, U.S.A
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Quintana JO, Talamo M, Liddy N, Sygall K, Tomaszewski P, Miller S, Sethi PM. Evaluating clinical outcomes of two biceps tenodesis techniques: Loop 'N' Tack and subpectoral biceps tenodesis. JSES Int 2024; 8:274-277. [PMID: 38464437 PMCID: PMC10920143 DOI: 10.1016/j.jseint.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Purpose Biceps tenodesis is an effective surgical procedure that can address pathologies of the long head of the biceps tendon. The purpose of this study was to evaluate clinical outcomes following two different biceps tenodesis techniques: Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis. Hypothesis Patients undergoing both the subpectoral biceps tenodesis and Loop 'N' Tack biceps tenodesis will have improvements in patient-reported outcomes. Methods Hundred and sixty five consecutive patients who underwent biceps tenodesis were retrospectively identified and contacted by phone to collect visual analog scale pain scores, University of California, Los Angeles shoulder scores, Simple Shoulder Test scores, Single Assessment Numeric Evaluation scores, and American Shoulder and Elbow Surgeons scores. Range of motion, elbow flexion strength, and incidence of bicipital groove pain and Popeye deformity were recorded. Results One Hundred and forty five patients were included in the study (55 subpectoral, 90 Loop 'N' Tack). Patients in both groups reported high American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California, Los Angeles, Single Assessment Numeric Evaluation shoulder function scores, low visual analog scale pain scores, and had a minimal risk of complications when measured one year postoperatively. Conclusion Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis techniques are reliable and effective procedures that can reduce pain scores and restore shoulder function when patients require surgical intervention.
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Affiliation(s)
- Julio Ojea Quintana
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Michael Talamo
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Nicole Liddy
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Kyle Sygall
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Paul Tomaszewski
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Seth Miller
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Paul M. Sethi
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
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Pearson ZC, Haft M, Agarwal AR, Rupp MC, Mikula JD, Ahiarakwe U, Best MJ, Srikumaran U. The Effect of Concomitant Biceps Tenodesis on Revision Surgery Rates After Primary Rotator Cuff Repair. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00013. [PMID: 38506707 PMCID: PMC10956974 DOI: 10.5435/jaaosglobal-d-24-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION We aimed to use a national database to compare the 4-year revision surgery rates after rotator cuff repair (RCR) in patients with concomitant biceps tenodesis (BT) versus those without BT. METHODS A retrospective cohort analysis was conducted using the PearlDiver database from 2015 to 2017. Patients undergoing primary open and arthroscopic RCR with and without BT were identified. Demographic variables, 90-day complications, and 2- and 4-year revision surgery rates were analyzed, and a multivariable logistic regression was conducted. RESULTS Of the 131,155 patients undergoing RCR, 24,487 (18.7%) underwent concomitant BT and 106,668 (81.3%) did not. After controlling for comorbidities and demographics, patients with concomitant BT were associated with lower odds of all-cause revision (OR; P-value [0.77; P < 0.001]), revision BT (0.65; P < 0.001), revision RCR (0.72; P < 0.001), and shoulder arthroplasty (0.81; P = 0.001) within 4 years when compared with those without concomitant BT. DISCUSSION In our analysis, patients undergoing primary RCR with concomitant BT had 35% reduced odds of revision BT and 23% reduced odds of any all-cause revision within 4 years when compared with those without concomitant BT. This suggests that tenodesis at the time of primary RCR may be associated with a reduction in the utilization of ipsilateral shoulder revision surgery rates.
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Affiliation(s)
- Zachary C. Pearson
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Pearson, Mr. Haft, Mr. Agarwal, Dr. Mikula, Mr. Ahiarakwe, Dr. Best, Dr. Srikumaran); Department of Orthopaedic Sports Medicine, The Steadman Clinic, Vail, CO (Dr. Rupp)
| | - Mark Haft
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Pearson, Mr. Haft, Mr. Agarwal, Dr. Mikula, Mr. Ahiarakwe, Dr. Best, Dr. Srikumaran); Department of Orthopaedic Sports Medicine, The Steadman Clinic, Vail, CO (Dr. Rupp)
| | - Amil R. Agarwal
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Pearson, Mr. Haft, Mr. Agarwal, Dr. Mikula, Mr. Ahiarakwe, Dr. Best, Dr. Srikumaran); Department of Orthopaedic Sports Medicine, The Steadman Clinic, Vail, CO (Dr. Rupp)
| | - Marco-Christopher Rupp
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Pearson, Mr. Haft, Mr. Agarwal, Dr. Mikula, Mr. Ahiarakwe, Dr. Best, Dr. Srikumaran); Department of Orthopaedic Sports Medicine, The Steadman Clinic, Vail, CO (Dr. Rupp)
| | - Jacob D. Mikula
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Pearson, Mr. Haft, Mr. Agarwal, Dr. Mikula, Mr. Ahiarakwe, Dr. Best, Dr. Srikumaran); Department of Orthopaedic Sports Medicine, The Steadman Clinic, Vail, CO (Dr. Rupp)
| | - Uzoma Ahiarakwe
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Pearson, Mr. Haft, Mr. Agarwal, Dr. Mikula, Mr. Ahiarakwe, Dr. Best, Dr. Srikumaran); Department of Orthopaedic Sports Medicine, The Steadman Clinic, Vail, CO (Dr. Rupp)
| | - Matthew J. Best
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Pearson, Mr. Haft, Mr. Agarwal, Dr. Mikula, Mr. Ahiarakwe, Dr. Best, Dr. Srikumaran); Department of Orthopaedic Sports Medicine, The Steadman Clinic, Vail, CO (Dr. Rupp)
| | - Uma Srikumaran
- From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Pearson, Mr. Haft, Mr. Agarwal, Dr. Mikula, Mr. Ahiarakwe, Dr. Best, Dr. Srikumaran); Department of Orthopaedic Sports Medicine, The Steadman Clinic, Vail, CO (Dr. Rupp)
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Benhenneda R, Brouard T, Charousset C, Berhouet J. Can artificial intelligence help decision-making in arthroscopy? Part 2: The IA-RTRHO model - a decision-making aid for long head of the biceps diagnoses in small rotator cuff tears. Orthop Traumatol Surg Res 2023; 109:103652. [PMID: 37380127 DOI: 10.1016/j.otsr.2023.103652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION The possible applications of artificial intelligence (AI) in orthopedic surgery are promising. Deep learning can be utilized in arthroscopic surgery due to the video signal used by computer vision. The intraoperative management of the long head of biceps (LHB) tendon is the subject of a long-standing controversy. The main objective of this study was to model a diagnostic AI capable of determining the healthy or pathological state of the LHB on arthroscopic images. The secondary objective was to create a second diagnostic AI model based on arthroscopic images and the medical, clinical and imaging data of each patient, to determine the healthy or pathological state of the LHB. HYPOTHESIS The hypothesis of this study was that it was possible to construct an AI model from operative arthroscopic images to aid in the diagnosis of the healthy or pathological state of the LHB, and its analysis would be superior to a human analysis. MATERIALS AND METHODS Prospective clinical and imaging data from 199 patients were collected and associated with images from a validated protocoled arthroscopic video analysis, called "ground truth", made by the operating surgeon. A model based on a convolutional neural network (CNN) modeled via transfer learning on the Inception V3 model was built for the analysis of arthroscopic images. This model was then coupled to MultiLayer Perceptron (MLP), integrating clinical and imaging data. Each model was trained and tested using supervised learning. RESULTS The accuracy of the CNN in diagnosing the healthy or pathological state of the LHB was 93.7% in learning and 80.66% in generalization. Coupled with the clinical data of each patient, the accuracy of the model assembling the CNN and MLP were respectively 77% and 58% in learning and in generalization. CONCLUSION The AI model built from a CNN manages to determine the healthy or pathological state of the LHB with an accuracy rate of 80.66%. An increase in input data to limit overfitting, and the automation of the detection phase by a Mask-R-CNN are ways of improving the model. This study is the first to assess the ability of an AI to analyze arthroscopic images, and its results need to be confirmed by further studies on this subject. LEVEL OF EVIDENCE III Diagnostic study.
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Affiliation(s)
- Rayane Benhenneda
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, faculté de médecine, université de Tours, Centre-Val-de-Loire, France.
| | - Thierry Brouard
- LIFAT (EA6300), école polytechnique universitaire de Tours, 64, avenue Jean-Portalis, 37200 Tours, France
| | | | - Julien Berhouet
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, faculté de médecine, université de Tours, Centre-Val-de-Loire, France; LIFAT (EA6300), école polytechnique universitaire de Tours, 64, avenue Jean-Portalis, 37200 Tours, France
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Clinker C, Simister SK, Thomas L, Da Silva A, Ishikawa H, Joyce C, Chalmers PN, Tashjian RZ. Revision Subpectoral Biceps Tenodesis Demonstrates a High Patient Satisfaction and Good Functional Outcomes. Arthrosc Sports Med Rehabil 2023; 5:100797. [PMID: 37746319 PMCID: PMC10511333 DOI: 10.1016/j.asmr.2023.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/04/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose To clinically evaluate a subset of patients who underwent a revision subpectoral biceps tenodesis for a clinically failed proximal biceps tenodesis. Methods This is a retrospective case series of patients with at least 2-year follow-up who had undergone a revision biceps tenodesis after clinical failure of a proximal biceps tenodesis between January 2008 and February 2020 by a single surgeon. Patients who underwent concomitant procedures, such as revision cuff repair, were excluded. Patients with a minimum of 2 years duration status postrevision subpectoral tenodesis were contacted for informed consent and outcome data, which included Simple Shoulder Test, American Shoulder and Elbow Surgeons score, visual analog scale for pain, and subjective reporting of arm weakness and satisfaction. Results Fourteen patients were initially identified as meeting inclusion criteria with a minimum 2-year follow-up achieved for 11 of 14 patients (78.5% follow-up). The mean follow-up time was 8.1 years (range, 2.7-14.8 years). After the primary biceps tenodesis, a mean of 8.0 ± 9.6 months passed before the revision subpectoral biceps tenodesis was performed. The average postoperative active forward elevation and adducted external rotation were 159 ± 7° and 47 ± 17°, respectively. The mean ± standard deviation (range) follow-up American Shoulder and Elbow Surgeons score was 79 ± 23 (30-100), Simple Shoulder Test was 11 ± 2 (7-12), and visual analog scale for pain was 2.6 ± 2.8 (0-9). All 11 patients reported being satisfied with their operation and would elect to have the operation again. Conclusions Revision subpectoral biceps tenodesis is a viable procedure for addressing patients with persistent pain following initial proximal biceps tenodesis. Although some persistent pain is common, revision subpectoral biceps tenodesis demonstrates a high patient satisfaction and good functional outcomes. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Christopher Clinker
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Samuel K. Simister
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Logan Thomas
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Adrik Da Silva
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Hiroaki Ishikawa
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Christopher Joyce
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Peter N. Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Robert Z. Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
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Colasanti CA, Azam MT, Bi AS, Fariyike B, Kirschner N, Neal WH, Owusu-Sarpong S, Stone JW, Kennedy JG. Reproducible and Effective Biceps Tenodesis Method Utilizing In-Office Nano-Arthroscopy. Arthrosc Tech 2023; 12:e1797-e1802. [PMID: 37942114 PMCID: PMC10628057 DOI: 10.1016/j.eats.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/19/2023] [Indexed: 11/10/2023] Open
Abstract
Biceps tendinopathy is a common cause of chronic anterior shoulder pain characterized by altered joint mechanics with considerable deficits in range of motion secondary to pain. The benefits of in-office nano-arthroscopy (IONA) include the ability to diagnosis and treat biceps tendinopathy, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing IONA for biceps tendinopathy (biceps tenotomy/biceps tenodesis), with special consideration for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.
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Affiliation(s)
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
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Drain NP, Greiner JJ, Simonian LE, Carlos NBT, Hyre ND, Smith C, Hughes JD, Lin A, Lesniak BP. Depressive and Anxiety Disorders Increase Risk for Recurrent Anterior Shoulder Pain Following Arthroscopic Suprapectoral Biceps Tenodesis. Arthrosc Sports Med Rehabil 2023; 5:e739-e749. [PMID: 37388874 PMCID: PMC10300603 DOI: 10.1016/j.asmr.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/05/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To evaluate factors associated with postoperative anterior shoulder pain following arthroscopic suprapectoral biceps tenodesis (ABT) and to determine the clinical impact of postoperative anterior shoulder pain. Methods A retrospective study of patients that underwent ABT between 2016 and 2020 was conducted. Groups were categorized by the presence (ASP+) or absence (ASP-) of postoperative anterior shoulder pain. Patient-reported outcomes (American Shoulder and Elbow score [ASES], visual analog scale [VAS] for pain, subjective shoulder value [SSV]), strength, range of motion, and complication rates were analyzed. Differences between continuous and categorical variables were tested with two-sample t-tests and chi-squared or Fisher's exact tests, respectively. Variables collected at different postoperative timepoints were analyzed using mixed models with post hoc comparisons when significant interactions were detected. Results A total of 461 (47 ASP+, 414 ASP-) patients were included. A statistically significant lower mean age was observed in the ASP+ group (P < .001). A statistically significant higher prevalence of major depressive disorder (MDD) (P = .03) or any anxiety disorder (P = .002) was observed in the ASP+ group. Prescription medication with psychotropic medications (P = .01) was significantly more prevalent in the ASP+ group. No significant differences were observed in the proportion of individuals reaching the minimal clinical important difference (MCID) for ASES, VAS, or SSV between groups. Conclusions A pre-existing diagnosis of major depressive disorder or any anxiety disorder, as well as the use of psychotropic medications was associated with postoperative anterior shoulder pain following ABT. Other factors associated with anterior shoulder pain included younger age, participation in physical therapy before surgery, and lower rate of concomitant rotator cuff repair or subacromial decompression. Although the proportion of individuals reaching MCID did not differ between groups, the presence of anterior shoulder pain after ABT resulted in prolonged recovery, inferior PROs, and a higher incidence of repeat surgical procedures. The decision to perform ABT in patients diagnosed with MDD or anxiety should be carefully considered, given the correlation to postoperative anterior shoulder pain and inferior outcomes. Level of Evidence Level III, retrospective case-control study.
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Affiliation(s)
- Nicholas P. Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Justin J. Greiner
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Lauren E. Simonian
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Noel Bien T. Carlos
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Nathan D. Hyre
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Clair Smith
- Department of Physical Therapy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Pittsburgh Shoulder Institute, Pittsburgh, Pennsylvania, U.S.A
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Pittsburgh Shoulder Institute, Pittsburgh, Pennsylvania, U.S.A
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Pittsburgh Shoulder Institute, Pittsburgh, Pennsylvania, U.S.A
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10
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Zhang C, Yang G, Li T, Pang L, Li Y, Yao L, Li R, Tang X. Biceps Tenodesis Better Improves the Shoulder Function Compared with Tenotomy for Long Head of the Biceps Tendon Lesions: A Meta-Analysis of Randomised Controlled Trials. J Clin Med 2023; 12:1754. [PMID: 36902540 PMCID: PMC10003204 DOI: 10.3390/jcm12051754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE Surgical options for long head of the biceps tendon (LHBT) lesions include tenotomy and tenodesis. This study aims to determine the optimal surgical strategy for LHBT lesions with updated evidence from randomised controlled trials (RCTs). METHODS Literature was retrieved from PubMed, Cochrane Library, Embase and Web of Science on 12 January 2022. Randomised controlled trials (RCTs) comparing the clinical outcomes of tenotomy and tenodesis were pooled in the meta-analyses. RESULTS Ten RCTs with 787 cases met the inclusion criteria, and were included in the meta-analysis. Constant scores (MD, -1.24; p = 0.001), improvement of Constant scores (MD, -1.54; p = 0.04), Simple Shoulder Test (SST) scores (MD, -0.73; p = 0.03) and improvement of SST (p < 0.05) were significantly better in patients with tenodesis. Tenotomy was associated with higher rates of Popeye deformity (OR, 3.34; p < 0.001) and cramping pain (OR, 3.36; p = 0.008]. No significant differences were noticed between tenotomy and tenodesis regarding pain (p = 0.59), American Shoulder and Elbow Surgeons (ASES) score (p = 0.42) and its improvement (p = 0.91), elbow flexion strength (p = 0.38), forearm supination strength (p = 0.68) and range of motion of shoulder external rotation (p = 0.62). Subgroup analyses showed higher Constant scores in all tenodesis types and significantly larger improvement of Constant scores regarding intracuff tenodesis (MD, -5.87; p = 0.001). CONCLUSIONS According to the analyses of RCTs, tenodesis better improves shoulder function in terms of Constant scores and SST scores, and reduces the risk of Popeye deformity and cramping bicipital pain. Intracuff tenodesis might offer the best shoulder function as measured with Constant scores. However, tenotomy and tenodesis provide similar satisfactory results for pain relief, ASES score, biceps strength and shoulder range of motion.
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Affiliation(s)
- Chunsen Zhang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guang Yang
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tao Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Long Pang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yinghao Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Yao
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ran Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xin Tang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
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11
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Yoğun Y, Bezirgan U, Dursun M, Armangil M. Is biceps tenodesis necessary when performing arthroscopic rotator cuff repair in patients older than 55 years? Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04707-8. [PMID: 36436066 DOI: 10.1007/s00402-022-04707-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/20/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In patients with arthroscopic rotator cuff repair, tenotomy and tenodesis are the most performed surgical procedures for the biceps long head (BLH) pathologies. Controversy continues as to which surgical procedure provides better results. This study aimed to compare the clinical outcomes of tenotomy and tenodesis applied to the biceps long head in patients who underwent arthroscopic rotator cuff repair. MATERIALS AND METHODS In our study, the clinical results of 706 patients who underwent arthroscopic rotator cuff repair with tenotomy or tenodesis on the long biceps head were evaluated retrospectively. Rotator cuff repair patients were divided into two groups as single-row and double-row repair patients. The clinical results of patients who underwent tenotomy and tenodesis in single-row (n = 383) and double-row (n = 323) repair groups were compared. The clinical outcomes of the patients who underwent tenotomy and tenodesis without distinction between double/single-row repair were also compared. Preoperative and postoperative clinical evaluations of the patients were made with Constant Shoulder Score (CSS) and visual pain scale (VAS). The presence of the Popeye sign in the arm, tenderness in the bicipital groove, and cramping in the biceps muscle in the postoperative period was evaluated and compared among groups. Preoperative and postoperative clinical results of the patients were compared within the groups. RESULTS A total of 706 patients with a mean age of 61.78 ± 20.94 years and a mean follow-up period of 29.15 ± 14.28 months were evaluated. The mean age of the tenodesis group (58.13 ± 8.47) was significantly lower than the tenotomy group (61.52 ± 22.58) (p < 0.05). The mean CSS and VAS mean postoperatively in the tenotomy group (n = 587) were 76.84 ± 12.74 and 2.29 ± 2.78. The postoperative mean CSS and VAS in the tenodesis group (n = 119) were 77.56 ± 11.23 and 2.64 ± 2.70. There was no statistically significant difference between the postoperative clinical scores of patients who underwent tenotomy and patients who underwent tenodesis (p > 0.05). There was no difference between the tenotomy and tenodesis groups regarding Popeye deformity (p = 0.980). Bicipital groove tenderness and cramping in the biceps muscle were significantly higher in the tenodesis group (p < 0.001, < 0.001). Tenodesis was performed in 68, and tenotomy was performed in 315 out of 383 patients who underwent single-row rotator cuff repair. Tenodesis was performed in 51, and tenotomy was performed in 272 of 334 patients who underwent double-row rotator cuff repair. When singe versus double-row groups was compared, there was no significant difference in VAS, CSS, Popeye sing, bicipital groove tenderness, or biceps muscle cramping. When tenotomy versus tenodesis was compared within single- and double-row repair groups, there was no significant difference in VAS or CSS. There was no difference between the tenotomy and tenodesis groups regarding Popeye deformity, but bicipital groove tenderness and muscle cramping were more in tenodesis groups regardless of the repair rows. CONCLUSIONS The effect of tenodesis versus tenotomy for BHL pathologies in patients who underwent arthroscopic rotator cuff repair was not significant for clinical scores, but bicipital groove tenderness and biceps muscle cramping were significantly higher in the tenodesis group.
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Affiliation(s)
- Yener Yoğun
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Hand Surgery Unit, Sıhhiye, Ankara, TR, Turkey.
| | - Uğur Bezirgan
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Hand Surgery Unit, Sıhhiye, Ankara, TR, Turkey
| | - Merve Dursun
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Ankara, Turkey
| | - Mehmet Armangil
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Hand Surgery Unit, Sıhhiye, Ankara, TR, Turkey
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12
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Hartland AW, Islam R, Teoh KH, Rashid MS. Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis. BMJ Open 2022; 12:e061954. [PMID: 36220319 PMCID: PMC9557260 DOI: 10.1136/bmjopen-2022-061954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The comparative clinical effectiveness of common surgical techniques to address long head of biceps (LHB) pathology is unclear. We synthesised the evidence to compare the clinical effectiveness of tenotomy versus tenodesis. DESIGN A systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach. DATA SOURCES EMBASE, Medline, PsycINFO and the Cochrane Library of randomised controlled trials were searched through 31 October 2021. ELIGIBILITY CRITERIA We included randomised controlled trials, reporting patient reported outcome measures, comparing LHB tenotomy with tenodesis for LHB pathology, with or without concomitant rotator cuff pathology. Studies including patients treated for superior labral anterior-posterior tears were excluded. No language limits were employed. All publications from database inception to 31 October 2021 were included. DATA EXTRACTION AND SYNTHESIS Screening was performed by two authors independently. A third author reviewed the article, where consensus for inclusion was required. Data were extracted by two authors. Data were synthesised using RevMan. Inverse variance statistics and a random effects model were used. RESULTS 860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included. Pooled analysis of patient-reported functional outcome measures data demonstrated comparable outcomes (n=10 studies; 403 tenotomy vs 416 tenodesis; standardised mean difference (SMD): 0.14, 95% CI -0.04 to 0.32, p=0.13). There was no significant difference for pain (Visual Analogue Scale) (n=8 studies; 345 tenotomy vs 350 tenodesis; MD: -0.11, 95% CI -0.28 to 0.06, p=0.21). Tenodesis resulted in a lower rate of Popeye deformity (n=10 studies; 401 tenotomy vs 410 tenodesis; OR: 0.29, 95% CI 0.19 to 0.45, p<0.00001). Tenotomy demonstrated shorter operative time (n=4 studies; 204 tenotomy vs 201 tenodesis; MD 15.2, 95% CI 1.06 to 29.36, p<0.00001). CONCLUSIONS Aside from a lower rate of cosmetic deformity, tenodesis yielded no significant clinical benefit to tenotomy for addressing LHB pathology. PROSPERO REGISTRATION NUMBER CRD42020198658.
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Affiliation(s)
| | - Raisa Islam
- Department of Trauma and Orthopaedic Surgery, Princess Alexandra Hospital, Harlow, UK
| | - Kar Hao Teoh
- Department of Trauma and Orthopaedic Surgery, Princess Alexandra Hospital, Harlow, UK
| | - Mustafa Saad Rashid
- Nuffield Department of Orthopaedics, Rheumatology, and Musckuloskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology, and Musckuloskeletal Sciences, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
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13
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Carvalho FF, Nolte PC, Pinheiro J, Guehring T, Egenolf M, Chatterjee T. Improvement in long head of biceps function and lower rate of biceps deformities after subpectoral tenodesis with cortical button and interference screw vs. arthroscopic tenotomy: a 4-year follow-up. JSES Int 2022; 6:820-827. [PMID: 36081695 PMCID: PMC9446215 DOI: 10.1016/j.jseint.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to evaluate clinical, cosmetic, and strength midterm outcomes in arthroscopic biceps tenotomy and subpectoral biceps tenodesis using bicortical endobutton and interference screw. Methods In this retrospective study, inclusion criteria were long head of the biceps (LHB) pathologies treated either with tenotomy or an additional tenodesis. Postoperative assessment included Long Head of Biceps Score (LHBS), age-adjusted Constant-Murley Score, and Subjective Shoulder Value. Elbow flexion and forearm supination strength were measured. The presence of Popeye sign, cramps, and tenderness over the bicipital grove was evaluated. Statistical analysis of continuous variables without normal distribution was performed using Mann-Whitney U test. Grouped analysis was performed using 2-way analysis of variance. Binominal data were analyzed using chi-square test. Results A total of 73 patients with a mean age of 63.1 ± 9.6 years and a mean follow-up of 4.2 ± 0.5 years were included. Tenotomy was performed in 34 and tenodesis in 39 patients. Tenodesis group displayed a significantly higher LHB score (P = .0006), but no significant differences were detected for the age-adjusted Constant-Murley Score and Subjective Shoulder Value. Tenodesis group showed a significantly lower rate of Popeye deformities (P = .0007) and tenderness over the bicipital groove (P = .004). Patients from the tenotomy group with biceps deformity showed a significantly higher mean contralateral supination strength (P = .002) but no significant difference in contralateral elbow flexion compared with patients without biceps deformity. There was one (1.4%) complication in the tenotomy group (postoperative shoulder stiffness). Conclusion Both techniques resulted in comparable outcome scores on preselected patients, with tenodesis leading to better LHB function. Tenodesis did not improve elbow flexion and forearm supination strength beyond the tenotomy; however, it reduced the frequency of biceps deformities and tenderness over the bicipital groove. Patients with a strong contralateral forearm supination strength could be at risk of developing a biceps deformity after tenotomy.
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Affiliation(s)
- Filipe Ferreira Carvalho
- Evangelisches Krankenhaus, Clinic for Trauma and Orthopaedic Surgery, Bad Dürkheim, Germany
- Medical Faculty Heidelberg of Heidelberg University, Heidelberg, Germany
- Corresponding author: Filipe Ferreira Carvalho, MD, MSc, Evangelisches Krankenhaus, Orthopädie und Unfallchirurgie, Dr.-Kaufmann-Str. 2, 67098 Bad Dürkheim, Germany.
| | - Philip-Christian Nolte
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen, Germany
| | - Joao Pinheiro
- Evangelisches Krankenhaus, Clinic for Trauma and Orthopaedic Surgery, Bad Dürkheim, Germany
| | - Thorsten Guehring
- Diakonie Klinikum, Paulinenhilfe, Clinic for Trauma Orthopaedic Surgery, Stuttgart, Germany
| | - Michael Egenolf
- Evangelisches Krankenhaus, Clinic for Trauma and Orthopaedic Surgery, Bad Dürkheim, Germany
| | - Thomas Chatterjee
- Evangelisches Krankenhaus, Clinic for Trauma and Orthopaedic Surgery, Bad Dürkheim, Germany
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14
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[Comparison of the effectiveness of the long head of the biceps tendon with or without proximal amputation after arthroscopic repair of the rotator cuff]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:845-852. [PMID: 35848181 PMCID: PMC9288905 DOI: 10.7507/1002-1892.202203056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To compare the effectiveness of the long head of the biceps tendon (LHBT) with or without proximal amputation after arthroscopic rotator cuff repair in the treatment of repairable rotator cuff tear with LHBT injury. METHODS The clinical data of 68 patients with LHBT injury combined with supraspinatus tendon tear who met the selection criteria between January 2016 and June 2020 were retrospectively analyzed. According to whether the proximal end of LHBT was cut off or not after arthroscopic rotator cuff repair, they were divided into LHBT fixation without cutting group (group A, 32 cases) and LHBT fixation with cutting group (group B, 36 cases). There was no significant difference in gender, age, operating side, preoperative supraspinatus tear width, Constant-Murley shoulder function scale, University of California Los Angeles (UCLA) score, and visual analogue scale (VAS) score between the two groups ( P>0.05). The operation time, elbow flexion muscle strength, and postoperative complications were compared between the two groups. The Constant-Murley shoulder function scale, UCLA score, and VAS score were used to evaluate the recovery of shoulder function before operation and at 3, 6, 12 months after operation. The acromion-humeral distance (AHD) was measured by Y-view X-ray film of the shoulder joint immediately after operation and at last follow-up. AHD and acromion-greater tubercle distance (AGT) were measured by musculoskeletal ultrasound at 0°, 30°, 60°, and 90° of abduction. RESULTS There was no significant difference in operation time between the two groups ( t=-0.740, P=0.463). Patients in both groups were followed up (13.0±0.7) months in group A and (13.1±0.8) months in group B, with no significant difference ( t=0.127, P=0.899). At last follow-up, the elbow flexor muscle strength of the two groups reached grade Ⅴ. Complications (including shoulder pain, deltoid atrophy, and rotator cuff re-tear) occurred in 6 patients (18.75%) in group A and 9 patients (25.00%) in group B, without neurovascular injury, surgical site infection, joint stiffness, LHBT spasmodic pain, and Popeye deformity. There was no significant difference in the incidence of complications between the two groups ( χ 2=0.385, P=0.535). The Constant-Murley shoulder function scale, UCLA score, and VAS score significantly improved in both groups at 3, 6, and 12 months after operation ( P>0.05). The above scores in group B were significantly better than those in group A at 3 and 6 months after operation ( P<0.05), and there was no significant difference between the two groups at 12 months after operation ( P>0.05). Y-view X-ray film measurement of the shoulder joint showed that the AHD of the two groups at last follow-up was less than that at immediate after operation, but the difference was not significant ( Z=-1.247, P=0.212); the AHD of group A was significantly greater than that of group B at last follow-up ( t=-2.291, P=0.025). During musculoskeletal ultrasound detection of abduction and shoulder lift, there was no significant difference in the reduction degree of AHD and AGT in group A with abduction of 0°-30° compared with group B ( P>0.05). The reduction degree of AHD and AGT in group A with abduction of 30°-60°, and the reduction degree of AGT in group A with abduction of 60°-90° were significantly smaller than those in group B ( P<0.05). CONCLUSION In arthroscopic rotator cuff repair, whether the proximal structure of LHBT is cut off or not after LHBT fixation can effectively improve the symptoms of patients and promote the recovery of shoulder joint function. Compared with preserving the proximal structure of LHBT, cutting the proximal structure of LHBT after LHBT fixation has more obvious pain relief within 6 months, and the latter had better stability above the shoulder joint.
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15
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Kawashima I, Sugaya H, Takahashi N, Matsuki K, Tokai M, Ishizuka S, Hiraiwa H, Imagama S. Biceps tenotomy versus soft-tissue tenodesis in females aged 60 years and older with rotator cuff tears. J Orthop Sci 2022; 27:786-791. [PMID: 34083089 DOI: 10.1016/j.jos.2021.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recently, to treat the long head of the biceps tendon lesions in addition to rotator cuff repair has been recommended. However, the differences in clinical outcomes between biceps tenotomy and tenodesis for middle-aged and elderly females remains unclear. The purpose of this study was to compare the outcomes of biceps tenotomy and soft-tissue tenodesis that were performed concurrently with arthroscopic rotator cuff repair in ≥60-year-old females. METHODS Female shoulders that underwent arthroscopic rotator cuff repair in our institute in 2016 were retrospectively reviewed. This study included 66 shoulders with concurrent biceps tenotomy or soft-tissue tenodesis: tenotomy group, 41 shoulders; soft-tissue tenodesis group, 25 shoulders. Clinical scores, biceps pain (visual analogue scale, VAS), Popeye deformity, and biceps strength (%contralateral side) were compared between the two groups. RESULTS The mean age was significantly higher in the tenotomy group than the soft-tissue tenodesis group (72 ± 4 and 68 ± 6 years, respectively; P = 0.002). There were no significant differences in post-operative JOA and UCLA scores between the groups. VAS for biceps pain was significantly higher at postoperative 6 months in the tenotomy group than the soft-tissue tenodesis group (2.9 ± 2.5 and 1.7 ± 1.6, respectively, P = 0.03), though there were no significant differences at postoperative 3, 12, and ≥24 months. Subjective evaluation of Popeye deformity was not significantly different between the groups. Postoperative biceps strength was significantly lower in the tenotomy group than the soft-tissue tenodesis group (89.9% and 102.8%, respectively, P = 0.02). CONCLUSIONS Both biceps tenotomy and soft-tissue tenodesis concurrent with rotator cuff repair in ≥60-year-old female patients resulted in good outcomes. Shoulders with soft-tissue tenodesis demonstrated earlier improvement in postoperative biceps pain and better postoperative biceps strength than those with tenotomy. There were no differences in objective and subjective Popeye deformity between tenotomy and soft-tissue tenodesis. The LHB procedures, tenotomy or tenodesis, can be selected depending on surgeons' preference.
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Affiliation(s)
- Itaru Kawashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan; Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan.
| | - Hiroyuki Sugaya
- Tokyo Sports & Orthopaedic Clinic, 4-29-9 Kami-ikebukuro, Toshima, Tokyo, 170-0012, Japan
| | - Norimasa Takahashi
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan
| | - Keisuke Matsuki
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan
| | - Morihito Tokai
- Tokyo Sports & Orthopaedic Clinic, 4-29-9 Kami-ikebukuro, Toshima, Tokyo, 170-0012, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hideki Hiraiwa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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16
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Vajda M, Szakó L, Hegyi P, Erőss B, Görbe A, Molnár Z, Kozma K, Józsa G, Bucsi L, Schandl K. Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:1037-1051. [PMID: 35254476 PMCID: PMC9001564 DOI: 10.1007/s00264-022-05338-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/01/2022] [Indexed: 12/29/2022]
Abstract
Background Pathology of the long head of the biceps tendon (LHBT) is a common disorder affecting muscle function and causing considerable pain for the patient. The literature on the two surgical treatment methods (tenotomy and tenodesis) is controversial; therefore, our aim was to compare the results of these interventions. Methods We performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. We included only randomized clinical trials. We searched five databases. During statistical analysis, odds ratios (OR) and weighted mean differences (WMD) were calculated for dichotomous and continuous outcomes, respectively, using the Bayesian method with random effect model. Results We included 11 studies in the systematic review, nine of these were eligible for the meta-analysis, containing data about 572 patients (279 in the tenodesis, 293 in the tenotomy group). Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). We did not find significant difference among the other outcomes. Conclusion Tenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-022-05338-9.
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Affiliation(s)
- Mátyás Vajda
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
| | - Lajos Szakó
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085 Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085 Hungary
| | - Anikó Görbe
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Department of Anaesthesiology and Intensive Therapy and Pain Management, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland
| | - Kincső Kozma
- Department of Ophtalmology, Medical School, University of Pécs, Rákóczi út 2, 7623 Pécs, Hungary
| | - Gergő Józsa
- Department of Paediatrics, Surgical Division, University of Pécs, József Attila u. 7, 7623 Pécs, Hungary
| | - László Bucsi
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
| | - Károly Schandl
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
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Degenhardt H, Pogorzelski J, Themessl A, Muench LN, Wechselberger J, Woertler K, Siebenlist S, Imhoff AB, Scheiderer B. Reliable Clinical and Sonographic Outcomes of Subpectoral Biceps Tenodesis Using an All-Suture Anchor Onlay Technique. Arthroscopy 2022; 38:729-734. [PMID: 34508820 DOI: 10.1016/j.arthro.2021.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/14/2021] [Accepted: 08/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes and structural integrity of primary subpectoral biceps tenodesis using an all-suture anchor onlay technique for long head of the biceps (LHB) tendon pathology. METHODS We conducted a retrospective case series with prospectively collected data of patients who underwent primary, isolated subpectoral biceps tenodesis with a single all-suture anchor onlay fixation between March 2017 and March 2019. Outcomes were recorded at a minimum follow-up of 12 months based on assessments of the American Shoulder and Elbow Surgeons (ASES) score, LHB score, and elbow flexion strength and supination strength measurements. The integrity of the tenodesis construct was evaluated using ultrasound. RESULTS Thirty-four patients were available for clinical and ultrasound examination at a mean follow-up of 18 ± 5 months. The mean ASES score significantly improved from 51.0 ± 14.2 points preoperatively to 89.8 ± 10.5 points postoperatively (P < .001). The minimal clinically important difference for the ASES score was 8.7 points, which was exceeded by 31 patients (91.2%). The mean postoperative LHB score was 92.2 ± 8.3 points. Regarding subcategories, an average of 47.2 ± 6.3 points was reached for "pain/cramps"; 26.4 ± 6.1 points, "cosmesis"; and 18.6 ± 2.6 points, "elbow flexion strength." Both elbow flexion strength and supination strength were similar compared with the nonoperated side (P = .169 and P = .210, respectively). In 32 patients, ultrasound examination showed an intact tenodesis construct, whereas 2 patients (5.9%) sustained failure of the all-suture anchor fixation requiring revision. CONCLUSIONS Primary subpectoral biceps tenodesis using an all-suture anchor onlay technique for pathology of the LHB tendon provides reliable clinical results and a relatively low failure rate (5.9%). LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Hannes Degenhardt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Themessl
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
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18
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Ergün S, Cırdı YU, Baykan SE, Akgün U, Karahan M. Clinical outcome comparison of suprapectoral and subpectoral tenodesis of the long head of the biceps with concomitant rotator cuff repair: A systematic review. Shoulder Elbow 2022; 14:6-15. [PMID: 35154394 PMCID: PMC8832701 DOI: 10.1177/1758573221989089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Simultaneous repairs of rotator cuff and biceps tenodesis can be managed by tenodesis of long head of biceps tendon to a subpectoral or suprapectoral area. This review investigated long head of biceps tendon tenodesis with concomitant rotator cuff repair and evaluated the clinical outcomes and incidences of complications based on tenodesis location. METHODS Medline, Cochrane, and Embase databases were searched for published, randomized or nonrandomized controlled studies and prospective or retrospective case series with the phrases "suprapectoral," "subpectoral," "tenodesis," and "long head of biceps tendon". Those with a clinical evidence Level IV or higher were included. Non-English manuscripts, review articles, commentaries, letters, case reports, and sole long head of biceps tendon tenodesis articles were excluded. RESULTS From 481 studies, 13 were chosen. In total, 1194 subpectoral and 2520 suprapectoral tenodesis cases were investigated. Postoperative Constant-Murley and American Shoulder and Elbow Surgeons mean scores showed similar good results. In terms of complication incidences, while transient nerve injuries were more commonly seen in patients with subpectoral tenodesis, persistent bicipital pain and Popeye deformity are mostly seen in patients with suprapectoral tenodesis. DISCUSSION Biceps tenodesis to suprapectoral or subpectoral area with concomitant rotator cuff repair demonstrated similar outcomes. Popeye deformity and persistent bicipital pain were higher in suprapectoral area and transient neuropraxia was found to be higher in subpectoral area.Level of evidence: IV.
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Affiliation(s)
- Selim Ergün
- Department of Orthopaedics and Traumatology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Yiğit Umur Cırdı
- Department of Orthopaedics and Traumatology, Yüksekova State Hospital, Hakkari, Turkey,Yiğit Umur Cırdı, Department of Orthopaedics and Traumatology, Yüksekova State Hospital, Hakkari 30300, Turkey.
| | - Said Erkam Baykan
- Department of Orthopaedics and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Umut Akgün
- Department of Orthopaedics and Traumatology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Mustafa Karahan
- Department of Orthopaedics and Traumatology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
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19
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Patel BH, Agarwalla A, Lu Y, Ouillette RJ, Forsythe B, Amin NH, Romeo AA, Liu JN. Isolated Biceps Tenodesis and Tenotomy: A Systematic Review of Indications and Patient Satisfaction. Orthopedics 2021; 44:333-340. [PMID: 34618647 DOI: 10.3928/01477447-20211001-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Biceps tenodesis and tenotomy are increasingly being used as treatment options for shoulder pathology, but patient satisfaction remains largely unstudied. A systematic review of the MEDLINE database was conducted to identify clinical outcome studies on isolated biceps tenodesis or tenotomy that reported patient satisfaction. Within the 15 investigations that were included, the indication for tenotomy was rotator cuff pathology, whereas the indication for tenodesis was biceps pathology or type 2 superior labral tear from anterior to posterior. Patients undergoing tenotomy were 13.6 years older than those undergoing tenodesis (P<.001). Patient satisfaction was high following both procedures, at 85.6% following tenotomy and 92.3% following tenodesis. [Orthopedics. 2021;44(6):333-340.].
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20
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Huddleston HP, Kurtzman JS, Gedailovich S, Koehler SM, Aibinder WR. The rate and reporting of fracture after biceps tenodesis: A systematic review. J Orthop 2021; 28:70-85. [PMID: 34880569 PMCID: PMC8633822 DOI: 10.1016/j.jor.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The purpose of this systematic review was to (1) define the cumulative humerus fracture rate after BT and (2) compare how often fracture rate was reported compared to other complications. METHODS A systematic review was performed using the PRISMA guidelines. RESULTS 39 studies reported complications and 30 reported no complications. Of the 39 studies that reported complications, 5 studies reported fracture after BT (n = 669, cumulative incidence of 0.53%). The overall non-fracture complication rate was 12.9%. DISCUSSION Due to the relatively high incidence of fracture, surgeons should ensure that this complication is disclosed to patients undergoing BT.
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Affiliation(s)
- Hailey P. Huddleston
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Joey S. Kurtzman
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Samuel Gedailovich
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Steven M. Koehler
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - William R. Aibinder
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
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21
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Candela V, Preziosi Standoli J, Carbone S, Rionero M, Gumina S. Shoulder Long Head Biceps Tendon Pathology Is Associated With Increasing Rotator Cuff Tear Size. Arthrosc Sports Med Rehabil 2021; 3:e1517-e1523. [PMID: 34712989 PMCID: PMC8527326 DOI: 10.1016/j.asmr.2021.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/18/2021] [Indexed: 11/01/2022] Open
Abstract
Purpose To evaluate the association between rotator cuff tear (RCT) size and long head biceps tendon (LHBT) pathology. Methods We retrospectively enrolled 202 consecutive patients (114 women and 88 men with mean age at surgery of 62.14 years [SD, 7.73]) who underwent arthroscopic rotator cuff repair for different sized full-thickness RCTs. LHBT pathology was evaluated considering the presence of inflammation, section alteration, loss of integrity, dislocation, dynamic instability, and absence. The site of LHBT pathology was evaluated considering 3 portions: (1) the insertional element; (2) the free intra-articular portion; (3) the part that enters the intertubercular groove. Statistics were evluated. Results The LHBT was absent in 22 cases (10.9%): 2, 4, 15, and 1 patients with small, large, massive, and subscapularis RCTs, respectively. A significant correlation was found between the prevalence of LHBT absence and massive RCTs (P < .001). In 53 patients (26%), there was a healthy LHBT; a healthy LHBT was present in 47%, 20% and 8% of small, large and massive RCTs, respectively. A significant correlation between LHBT inflammation, section alteration, loss of integrity, and RCT severity was found (P < .001, P < .001, and ). The insertional portion was the most involved (57% of cases); RCT severity was significantly associated with the number of involved portions (P < .001). Conclusions Shoulder LHBT pathology is associated with increasing rotator cuff tear size. Clinical Relevance Surgeons should be aware that biceps pathology is particularly prevalent in patients with larger RTCs.
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Affiliation(s)
- Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy.,Istituto Clinico Ortopedico Traumatologico, Latina, Italy
| | | | - Stefano Carbone
- Sapienza Univerisity, Sant'Andrea Hospital (X.X.X. ), Rome, Italy
| | - Marco Rionero
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy.,Istituto Clinico Ortopedico Traumatologico, Latina, Italy
| | - Stefano Gumina
- Shoulder Unit, San Feliciano Clinic, Rome, Italy.,Istituto Clinico Ortopedico Traumatologico, Latina, Italy
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22
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Panico L, Roy T, Namdari S. Long Head of the Biceps Tendon Ruptures: Biomechanics, Clinical Ramifications, and Management. JBJS Rev 2021; 9:01874474-202110000-00007. [PMID: 34695033 DOI: 10.2106/jbjs.rvw.21.00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Pathology of the long head of the biceps tendon is a common source of shoulder pain and often occurs in combination with other shoulder disorders. » Nonsurgical management, including rest and activity modification, use of nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections, is usually the first line of treatment. » Patients with symptoms that are refractory to nonsurgical management are indicated for biceps tenotomy or various tenodesis procedures. » Although several studies have reported a higher incidence of "Popeye" deformity, muscle cramping, and pain in the bicipital groove postoperatively with tenotomy compared with tenodesis, there are no substantial differences in functional scores or patient satisfaction between the 2 techniques. » To date, both tenotomy and tenodesis have been shown to be effective options in the management of long head of the biceps tendinopathy, and there are advantages to each procedure.
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Affiliation(s)
- Leighann Panico
- Department of Orthopedic Surgery, UPMC Pinnacle, Harrisburg, Pennsylvania
| | - Trinava Roy
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Surena Namdari
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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23
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向 先, 刘 宇, 陈 荣, 刘 宇, 弓 爵, 李 丹, 王 卫. [Effectiveness comparison of arthroscopic intertubercular groove and open subpectoral tenodesis for long head of biceps tendon tendinopathy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1293-1297. [PMID: 34651483 PMCID: PMC8505942 DOI: 10.7507/1002-1892.202103223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/05/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon (LHBT) tendinopathy. METHODS A clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases (group A) and open subpectoral tenodesis was performed in 40 cases (group B). There was no significant difference in the gender, age, side of the affected shoulder joint, disease duration, and preoperative pain visual analogue scale (VAS) score, Constant score, American Society of Shoulder and Elbow Surgery (ASES) score, Disability of Arm, Shoulder, and Hand (DASH) score, LHBT score (LHBS) between the two groups ( P>0.05). The operation time and the scores of shoulder joint pain and function at 12 months after operation were compared between the two groups. RESULTS The operation time was (3.6±2.5) minutes in group A and (8.5±2.3) minutes in group B, showing a significant difference ( t=18.584, P=0.000). The incisions of the two groups healed by first intention, and there was no complication such as infection or thrombosis. All patients were followed up. The follow-up time was 24-30 months (mean, 26.0 months) in group A and 24-31 months (mean, 26.0 months) in group B. Both Speed test and Yergason test were negative at 3 months after operation. MRI showed that there was no obvious effusion around the LHTB and no dislocation of LHTB. At 12 months after operation, the VAS score, Constant score, ASES score, DASH score, and LHBS score of the two groups all improved when compared with preoperative ones ( P<0.05), and there was no significant difference in the differences before and after operation between the two groups ( P>0.05). No Popeye sign appeared during the follow-up. CONCLUSION The arthroscopic intertubercular groove and open subpectoral tenodesis can effectively relieve shoulder pain and improve function, but the former has shorter operation time and less trauma.
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Affiliation(s)
- 先祥 向
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 宇鹏 刘
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 荣进 陈
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 宇 刘
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 爵 弓
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 丹妹 李
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 卫明 王
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
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24
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Ahmed AF, Toubasi A, Mahmoud S, Ahmed GO, Al Ateeq Al Dosari M, Zikria BA. Long head of biceps tenotomy versus tenodesis: a systematic review and meta-analysis of randomized controlled trials. Shoulder Elbow 2021; 13:583-591. [PMID: 34804206 PMCID: PMC8600672 DOI: 10.1177/1758573220942923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare tenotomy versus tenodesis for the treatment of long head of the biceps tendon pathologies. The primary outcome was the shoulder functional outcome. The secondary outcomes consisted of postoperative pain, elbow flexion and forearm supination strengths and postoperative complications. METHODS PubMed, MEDLINE, Google Scholar and Web of Science were searched until April 2020. Included studies were randomized controlled trials with a minimum 12 months' follow-up. RESULTS Both treatments had similar improvement on the Constant-Murley score at 6 months and 12 months. However, tenotomy had a significantly lower Constant-Murley score at two years with a mean difference of -1.13 (95% confidence interval -1.9, -0.35). Furthermore, tenotomy had a risk ratio of 2.46 (95% confidence interval 1.66, 3.64) for developing Popeye's deformity. No significant difference was detected in other functional outcomes, pain, or elbow flexion and forearm strength indices. DISCUSSION Tenodesis and tenotomy are both well-established techniques that similarly yield satisfactory outcomes. Despite that tenodesis had a statistically significant better Constant-Murley score at two years, this was clinically irrelevant. With the current evidence, we recommend either technique for the management of the long head of the biceps tendon pathologies. LEVEL OF EVIDENCE Therapeutic, Level II.
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Affiliation(s)
- Abdulaziz F Ahmed
- Section of Orthopedics, Department of
Surgery,
Hamad
General Hospital, Doha, Qatar,Abdulaziz F Ahmed, Section of Orthopedics,
Department of Surgery, Hamad General Hospital, PO Box 3050, Doha, Qatar.
| | - Ammar Toubasi
- Section of Orthopedics, Department of
Surgery,
Hamad
General Hospital, Doha, Qatar
| | - Shady Mahmoud
- Department of Orthopaedic Surgery,
Albert Einstein College of Medicine, Bronx, USA
| | - Ghalib O Ahmed
- Section of Orthopedics, Department of
Surgery,
Hamad
General Hospital, Doha, Qatar
| | | | - Bashir A Zikria
- Department of Orthopaedic Surgery,
Division of Sports Medicine, Johns Hopkins University School of Medicine, Baltimore,
USA
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25
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Kooistra B, Gurnani N, Weening A, van Deurzen D, van den Bekerom M. Tenotomy or Tenodesis for Tendinopathy of the Long Head of the Biceps Brachii: An Updated Systematic Review and Meta-analysis. Arthrosc Sports Med Rehabil 2021; 3:e1199-e1209. [PMID: 34430901 PMCID: PMC8365216 DOI: 10.1016/j.asmr.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/25/2021] [Indexed: 01/29/2023] Open
Abstract
Purpose The purpose of this meta-analysis was to provide an up-to-date comparison of clinical outcomes of tenotomy and tenodesis in the surgical treatment of long head of the biceps brachii (LHB) tendinopathy. Methods A literature search was conducted in EMBASE, Pubmed/Medline and the Cochrane database from January 2000 to May 2020. All studies comparing clinical outcomes between LHB tenotomy and tenodesis were included. Quality was assessed using the Coleman score. Results We included 25 studies (8 randomized studies) comprising 2,191 patients undergoing LHB tenotomy or tenodesis, with or without concomitant shoulder procedures (mainly rotator cuff repairs). The Coleman score ranged from 29 to 97 for all studies. When comparing tenodesis and tenotomy in randomized studies, no clinically relevant differences were found in the Constant score (mean difference, 0.9 points), the American Shoulder and Elbow Society Score (mean difference, 1.1 points), shoulder pain (mean difference in visual analogue scale, -0.3 points), elbow flexion strength loss (mean difference, 0%), or forearm supination strength (mean difference, 3%). A Popeye deformity (odds ratio, 0.32) was less commonly seen in patients treated with tenodesis (9% vs 23%). Conclusion In our meta-analysis, a Popeye deformity was more frequently observed in patients treated with tenotomy. Based on a substantial number of studies, there is no evidence-based benefit of LHB tenodesis over tenotomy in terms of shoulder function, shoulder pain or biceps-related strength. It is unclear whether LHB tenodesis is of benefit in specific patient groups such as younger individuals. Level of evidence Level III, systematic review of level III or higher studies.
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Affiliation(s)
- Bauke Kooistra
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, the Netherlands.,Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Navin Gurnani
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, the Netherlands
| | - Alexander Weening
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, the Netherlands
| | - Derek van Deurzen
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, the Netherlands
| | - Michel van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands
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26
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Aldon-Villegas R, Perez-Cabezas V, Chamorro-Moriana G. Efficacy of management of associated dysfunctions on rotator cuff and long head of the biceps: systematic review. J Orthop Surg Res 2021; 16:501. [PMID: 34399799 PMCID: PMC8365915 DOI: 10.1186/s13018-021-02621-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background The important functional role the rotator cuff (RC) and biceps play in the shoulder, the close anatomical relationship between them and the high incidence of injuries require an appropriate multidisciplinary therapeutic approach after a rigorous assessment. The objective is to identify and analyze surgical interventions, whether or not followed by a postsurgical one, of associated dysfunctions on the RC and long head of the biceps (LHB) and their effectiveness in improving shoulder functionality. Methods A systematic review based on PRISMA protocol was conducted using PubMed, Web of Science, PEDro, Scopus, CINAHL, and Dialnet until 22 April 2021. The main inclusion criteria were as follows: randomized clinical trials including subjects diagnosed with RC and LHB lesions who had surgical and/not post-surgical treatments. The methodological quality of trials was evaluated by the PEDro scale. Data were shown in 3 pre-established tables: (1)sample data, diagnostic methods, dysfunctions and injury frequency, interventions, outcome measures and results; (2)significance and effectiveness of interventions; and (3)comparison of the effectiveness of interventions. Results Eleven studies were selected. The methodological quality of ten of them was assessed as good and one excellent (PEDro scale). All articles had surgical treatments and ten had postoperative management. All trials used arthroscopy and two open surgery too. Single-row, double-row and transosseous repair were used for RC lesions, while SLAP repair, tenotomy, and tenodesis were applied to LHB injuries. Measured parameters were functionality, pain, Popeye’s sign, strength, range of motion, satisfaction degree, biceps cramping, and quality of life. All approaches in general, surgical plus postsurgical, were always effective to the parameters measured in each study. Seven trials compared tenotomy and tenodesis: four of them obtained statistically significant differences in favor of tenodesis in Popeye’s sign, cramping, satisfaction degree, and/or forearm supination strength; and one, in favor of tenotomy in cramping. All studies measured functionality using functional assessment scales. The most widely used was the Constant Score. Conclusions Surgical plus post-surgical interventions in associated dysfunctions on RC and LHB were effective. Tenodesis obtained better results than tenotomy in Popeye’s sign, satisfaction, and forearm supination strength. However, there was no difference regarding biceps cramping. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02621-0.
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Affiliation(s)
- Rocio Aldon-Villegas
- Department of Physiotherapy, Research Group "Area of Physiotherapy" CTS-305, University of Seville, 41009, Seville, Spain
| | - Veronica Perez-Cabezas
- Department of Nursing and Physiotherapy, Research Group "Empowering Health by Physical Activity, Exercise and Nutrition" CTS-1038, University of Cadiz, 11009, Cadiz, Spain
| | - Gema Chamorro-Moriana
- Department of Physiotherapy, Research Group "Area of Physiotherapy" CTS-305, University of Seville, 41009, Seville, Spain.
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27
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Woodmass JM, McRae SMB, Lapner PL, Sasyniuk T, Old J, Stranges G, Dubberly J, Verhulst FV, MacDonald PB. Effect of age, gender, and body mass index on incidence and satisfaction of a Popeye deformity following biceps tenotomy or tenodesis: secondary analysis of a randomized clinical trial. J Shoulder Elbow Surg 2021; 30:1733-1740. [PMID: 34022365 DOI: 10.1016/j.jse.2021.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the incidence of Popeye deformity following biceps tenotomy vs. tenodesis and evaluate risk factors and subjective and objective outcomes. METHODS Data for this study were collected as part of a randomized clinical trial in which patients aged ≥18 years undergoing arthroscopic shoulder surgery for a long head of the biceps tendon lesion were allocated to undergo tenotomy or tenodesis. The primary outcome measure for this secondary analysis was rate of Popeye deformity at 24 months postoperation as determined by an evaluator blinded to group allocation. Those with a deformity indicated their satisfaction with the appearance of their arm on a 10-cm visual analog scale, rated their pain and cramping, and completed the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form and the Western Ontario Rotator Cuff index. Isometric elbow flexion and supination strength were also measured. Cohen kappa was calculated to measure inter-rater reliability between patient and evaluator on the presence of a deformity. Logistic regression was performed to identify predictors of presence or absence of a Popeye deformity. RESULTS One hundred fourteen patients were randomly assigned to 2 groups, of which 42 to the tenodesis group and 45 to the tenotomy group completed a 24-month follow-up. Based on clinical observation, the odds of a Popeye in the tenotomy group were 4.3 times greater than in the tenodesis group (P = .018) with incidence of 33% (15/45) and 9.5% (4/42), respectively. Surgical technique was the only significant predictor of perceived deformity, with male gender trending toward significance (odds ratio 7.33, 95% confidence interval 0.867-61.906, P = .067). Mean (standard deviation) satisfaction score of those with a deformity regarding appearance of their arm was 7.3 (2.6). Increasing satisfaction was correlated with increasing age (r = 0.640, P = .025), but there was no association with gender (r = -0.155, P = .527) or body mass index (r = -0.221, P = .057). Differences in subjective outcomes were dependent on whether the Popeye was clinician- or self-assessed. CONCLUSION The odds of developing a perceived Popeye deformity was 4.3 higher after tenotomy compared to tenodesis based on clinician observation. Male gender was trending toward being predictive of having a deformity. Pain and cramping were increased in those with a self-reported Popeye. Younger patients were significantly less satisfied with a deformity despite no difference in functional outcomes at 24 months. Thus, biceps tenodesis may be favored in younger male patients to minimize the risk of Popeye and the risk of dissatisfaction in the appearance of their arm following surgery.
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Affiliation(s)
| | | | - Peter L Lapner
- Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Treny Sasyniuk
- Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Jason Old
- Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Greg Stranges
- Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Jamie Dubberly
- Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
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van Deurzen DFP, Auw Yang KG, Onstenk R, Raven EEJ, van den Borne MPJ, Hoelen MA, Wessel RN, Willigenburg NW, Klaassen AD, van den Bekerom MPJ. Long Head of Biceps Tenotomy Is Not Inferior to Suprapectoral Tenodesis in Arthroscopic Repair of Nontraumatic Rotator Cuff Tears: A Multicenter, Non-inferiority, Randomized, Controlled Clinical Trial. Arthroscopy 2021; 37:1767-1776.e1. [PMID: 33556551 DOI: 10.1016/j.arthro.2021.01.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if long head of the biceps (LHB) tenotomy is not inferior to suprapectoral LHB tenodesis when performed in conjunction with arthroscopic repair of small- to medium-sized nontraumatic rotator cuff tears. METHODS This multicenter, randomized, non-inferiority trial recruited 100 participants older than 50 years who had a supraspinatus and/or infraspinatus tear sagittally smaller than 3 cm and arthroscopically confirmed LHB pathology. During arthroscopic rotator cuff repair, we randomized 48 patients to undergo suprapectoral LHB tenodesis and 52 patients to undergo LHB tenotomy. Data were collected preoperatively and at 6 weeks, 3 months, and 1 year postoperatively. The primary outcome was non-inferiority of the Constant-Murley score (CMS) at 1-year follow-up. Secondary outcomes included the Dutch Oxford Shoulder Score; Disabilities of the Arm, Shoulder and Hand questionnaire; Popeye deformity; elbow flexion strength index; arm cramping pain; and quality of life (EQ-5D score). The integrity of the rotator cuff repair was assessed with magnetic resonance imaging. Differences between intervention groups were analyzed by mixed modeling. RESULTS The mean CMS in the LHB tenotomy group improved from 44 (95% confidence interval [CI], 39-48) to 73 (95% CI, 68-79). In patients with LHB tenodesis, the mean CMS improved from 42 (95% CI, 37-48) to 78 (95% CI, 74-82). The difference between groups at 1-year follow-up was 4.8 (97.5% CI, -∞ to 11.4), with a P value for non-inferiority of .06. The secondary outcomes also improved over time, with no remarkable differences between groups. A Popeye deformity occurred in 33% of tenodesis patients and 47% of tenotomy patients (P = .17). Tenotomy was performed with a shorter operative time (73 minutes vs 82 minutes, P = .03). Magnetic resonance imaging showed a recurrent rotator cuff tear in 20% of all cases. CONCLUSIONS Although statistically "inconclusive" regarding non-inferiority of the CMS at 1-year follow-up, any observed differences between patients with LHB tenotomy and those with LHB tenodesis in all outcome scores were small. LEVEL OF EVIDENCE Level I, randomized controlled trial and treatment study.
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Affiliation(s)
- Derek F P van Deurzen
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands.
| | - Kiem G Auw Yang
- Department of Orthopedic Surgery, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Ron Onstenk
- Department of Orthopedic Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - Eric E J Raven
- Department of Orthopedic Surgery, Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | | | - Max A Hoelen
- Department of Orthopedic Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Ronald N Wessel
- Department of Orthopedic Surgery, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Nienke W Willigenburg
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Amanda D Klaassen
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands
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El Helou A, Sebaaly A, El Rassi J, Taslakian B, Ghanem I, El Abyad R. Measurement of biceps tendon retraction after arthroscopic tenotomy. J Shoulder Elbow Surg 2021; 30:1369-1374. [PMID: 32919051 DOI: 10.1016/j.jse.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND One of the treatment options for long head of the biceps tendon (LHBT) pathology is tenotomy. To our knowledge, no study in the literature has evaluated the degree of retraction after tenotomy. The goals of this study were to determine the distance of this retraction and to identify its relationship with patient characteristics. METHODS We conducted an observational prospective survey over a 3-month period among 30 patients operated on arthroscopically by the same surgeon between August 2018 and April 2019. A radiopaque device was introduced inside the LHBT before tenotomy. Radiographs were obtained to evaluate the distance of retraction on day 1, day 30, and day 90. RESULTS Thirty patients were included, of whom 63.3% (19) were women. Surgery was performed for a rotator cuff tear in 10 patients (33.3%) and for subacromial impingement in the remainder of patients (66.7%) after failure of conservative management. The mean retraction of the LHBT (distance between the glenoid and clip) increased from 1.9 cm (day 1) to 3.5 cm (day 90). Three radiographic measurements were performed, and all 3 showed significant increases from day 1 to day 90. According to the Student t test, the mean retraction in the subacromial impingement group was significantly higher than that in the rotator cuff tear group on day 1, day 30, and day 90. Body mass index, younger age, sex, and dominant hand did not show any relation with LHBT retraction (P > .05). The mean LHBT retraction was significantly higher on day 90 in patients presenting with a positive Popeye sign (P < .05). CONCLUSION At 3 months of follow-up, the mean LHBT retraction was 3.5 cm from the glenoid and 2.5 cm from the greater tuberosity. It dynamically increased from day 1 to day 90. The LHBT will retract and sit beyond the transverse humeral ligament in the bicipital groove. The LHBT retracts significantly more when early mobilization of the shoulder is allowed.
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Affiliation(s)
- Abdo El Helou
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon.
| | - Amer Sebaaly
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joe El Rassi
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon
| | - Betty Taslakian
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Rami El Abyad
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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30
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Belk JW, Thon SG, Hart J, McCarty EC, McCarty EC. Subpectoral versus suprapectoral biceps tenodesis yields similar clinical outcomes: a systematic review. J ISAKOS 2021; 6:356-362. [PMID: 34016736 DOI: 10.1136/jisakos-2020-000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/04/2022]
Abstract
IMPORTANCE Arthroscopic suprapectoral biceps tenodesis (ABT) and open subpectoral biceps tenodesis (OBT) are two surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior to posterior (SLAP) tears. There is insufficient knowledge regarding the clinical superiority of one technique over the other. OBJECTIVE To systematically review the literature in order to compare the clinical outcomes and safety of ABT and OBT for treatment of LHBT or SLAP pathology. EVIDENCE REVIEW A systematic review was performed by searching PubMed, the Cochrane Library and Embase to identify studies that compared the clinical efficacy of ABT versus OBT. The search phrase used was: (bicep OR biceps OR biceps brachii OR long head of biceps brachii OR biceps tendinopathy) AND (tenodesis). Patients were assessed based on the American Shoulder and Elbow Surgeons Score, the visual analogue scale, the Single Assessment Numeric Evaluation, Constant-Murley Score, clinical failure, range of motion, bicipital groove pain and strength. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and both the Cochrane Collaboration's and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) risk of bias tools were used to evaluate risk of bias. FINDINGS Eight studies (one level I, seven level III) met inclusion criteria, including 326 patients undergoing ABT and 381 patients undergoing OBT. No differences were found in treatment failure rates or patient-reported outcome scores between groups in any study. One study found OBT patients to experience significantly increased range of shoulder forward flexion when compared with ABT patients (p=0.049). Two studies found ABT patients to experience significantly more postoperative stiffness when compared with OBT patients (p<0.05). CONCLUSIONS Patients undergoing ABT and OBT can be expected to experience similar improvements in clinical outcomes at latest follow-up without differences treatment failure or functional performance. ABT patients may experience an increased incidence of stiffness in the early postoperative period. LEVEL OF EVIDENCE III.
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Affiliation(s)
- John W Belk
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Stephen G Thon
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA.,Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - John Hart
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA.,Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Eric C McCarty
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA .,Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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31
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Zhu XM, Leroux T, Ben-David E, Dennis B, Gohal C, Kirsch JM, Khan M. A meta-analysis of level I evidence comparing tenotomy vs tenodesis in the management of long head of biceps pathology. J Shoulder Elbow Surg 2021; 30:961-968. [PMID: 33607334 DOI: 10.1016/j.jse.2021.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The ideal surgical treatment of long head of biceps pathology is unclear. This review evaluates Level I studies comparing tenotomy and tenodesis for the management of long head of biceps pathology. METHODS Medline, EMBASE, and the Cochrane Library databases were searched from database inception though April 17, 2020. Clinical outcomes including Constant-Murley Shoulder Outcome Score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) shoulder score, pain on visual analog scale, postoperative strength, and Popeye deformity were evaluated. Dichotomous outcomes were pooled into relative risk ratios whereas continuous outcomes were pooled into weighted mean differences using random effects meta-analysis. RESULTS A total of 5 studies (227 tenotomy and 227 tenodesis patients) met the final inclusion criteria. Postoperative improvement across all outcomes was observed regardless of surgical treatment. Pooled analysis demonstrated no statistically significant difference for Constant-Murley Shoulder Outcome Score, ASES, pain, or flexion strength. Tenodesis was superior to tenotomy in reducing the risk of Popeye deformity (relative risk ratio 3.07, confidence interval 1.87, 5.02; P < .001). CONCLUSION Tenotomy and tenodesis of the long head of the biceps results in comparable postoperative clinical and functional outcomes. Tenodesis is superior to tenotomy in preventing Popeye deformity postoperatively.
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Affiliation(s)
- Xi Ming Zhu
- St George's University Hospitals NHS Foundation Trust, St. George's, University of London, Tooting, London, UK; St George's, University of London, Tooting, London, UK
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Eyal Ben-David
- St George's University Hospitals NHS Foundation Trust, St. George's, University of London, Tooting, London, UK; St George's, University of London, Tooting, London, UK
| | - Brittany Dennis
- St George's, University of London, Tooting, London, UK; Internal Medicine Program, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Chetan Gohal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jacob M Kirsch
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
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Biceps tenodesis versus tenotomy: a systematic review and meta-analysis of level I randomized controlled trials. J Shoulder Elbow Surg 2021; 30:951-960. [PMID: 33373685 DOI: 10.1016/j.jse.2020.11.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Biceps tenodesis and tenotomy are 2 surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior-to-posterior (SLAP) tears. The purpose of this systematic review was to compare the clinical outcomes and complications of biceps tenodesis and tenotomy for the treatment of LHBT or SLAP pathology during shoulder arthroscopy. METHODS We performed a systematic review by searching PubMed, the Cochrane Library, and Embase to identify level I randomized controlled trials that compared the clinical outcomes of biceps tenodesis vs. tenotomy. The search phrase used was as follows: biceps tenodesis tenotomy randomized. Patients were assessed based on the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, and Constant-Murley score, as well as postoperative range of motion, strength, and cosmetic deformity. RESULTS Five studies (all level I) met the inclusion criteria, including 236 patients undergoing biceps tenodesis (mean age, 60.3 years) and 232 patients undergoing biceps tenotomy (mean age, 59.7 years). The mean follow-up period was 23.0 months. Overall, 6.8% of tenodesis patients experienced cosmetic deformity at latest follow-up compared with 23.3% of tenotomy patients (P < .001). No differences in Constant-Murley, visual analog scale, or American Shoulder and Elbow Surgeons scores were found between groups in any study, and of all the studies evaluating strength and range of motion at latest follow-up, only 1 found a significant difference between groups, in which tenodesis patients demonstrated significantly increased forearm supination strength (P = .02). One study found tenodesis patients to experience significantly more biceps cramping at 6-month follow-up compared with tenotomy patients (P = .043), although no differences in complication rates at latest follow-up were found in any study. CONCLUSION Patients undergoing treatment for LHBT or SLAP pathology with either biceps tenodesis or tenotomy can be expected to experience similar improvements in patient-reported and functional outcomes. There is an increased rate of cosmetic deformity in patients undergoing biceps tenotomy compared with tenodesis.
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ÖZÇAMDALLI M, EKEN G, GÜNAY M, YETİŞ M. Rotator Manşet Tedavisi Sırasında Biseps Uzun Başı Patolojilerinin Tedavisinde Artroskopik Tenodez Ve Tenotominin Sonuçlarının Karşılaştırılması. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.783683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Liu H, Song X, Liu P, Yu H, Zhang Q, Guo W. Clinical Outcomes of Arthroscopic Tenodesis Versus Tenotomy for Long Head of the Biceps Tendon Lesions: A Systematic Review and Meta-analysis of Randomized Clinical Trials and Cohort Studies. Orthop J Sports Med 2021; 9:2325967121993805. [PMID: 33997057 PMCID: PMC8071980 DOI: 10.1177/2325967121993805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background Controversy exists concerning whether tenotomy or tenodesis is the optimal surgical treatment option for proximal biceps tendon lesions. Purpose To evaluate the clinical outcomes after arthroscopic tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed by searching PubMed, the Cochrane Library, Web of Science, and Embase to identify randomized controlled trials (RCTs) and cohort studies that compared the clinical efficacy of tenotomy with that of tenodesis for LHBT lesions. A standardized data extraction form was predesigned to obtain bibliographic information of the study as well as patient, intervention, comparison, and outcome data. A random-effects model was used to pool quantitative data from the primary outcomes. Results A total of 21 eligible studies were separated into 3 methodological groups: (1) 4 RCTs with level 1 evidence, (2) 3 RCTs and 4 prospective cohort studies with level 2 evidence, and (3) 10 retrospective cohort studies with level 3 to 4 evidence. Analysis of the 3 groups demonstrated a significantly higher risk of the Popeye sign after tenotomy versus tenodesis (group 1: risk ratio [RR], 3.29 [95% CI, 1.92-5.49]; group 2: RR, 2.35 [95% CI, 1.43-3.85]; and group 3: RR, 2.57 [95% CI, 1.33-4.98]). Arm cramping pain remained significantly higher after tenotomy only in the retrospective cohort group (RR, 2.17 [95% CI, 1.20-3.95]). The Constant score for tenotomy was significantly worse than that for tenodesis in the prospective cohort group (standardized mean difference [SMD], -0.47 [95% CI, -0.73 to -0.21]), as were the forearm supination strength index (SMD, -0.75 [95% CI, -1.28 to -0.21]) and the Simple Shoulder Test (SST) score (SMD, -0.60 [95% CI, -0.94 to -0.27]). Conclusion The results demonstrated that compared with tenodesis, tenotomy had a higher risk of a Popeye deformity in all 3 study groups; worse functional outcomes in terms of the Constant score, forearm supination strength index, and SST score according to prospective cohort studies; and a higher incidence of arm cramping pain according to retrospective cohort studies.
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Affiliation(s)
- Hongzhi Liu
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Pei Liu
- Henan Luoyang Orthopedic-Traumatological Hospital, Zhengzhou, China
| | - Huachen Yu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.,Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.,Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
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Ek ET, Philpott AJ, Flynn JN, Richards N, Hardidge AJ, Rotstein AH, Wood AD. Characterization of the Proximal Long Head of Biceps Tendon Anatomy Using Magnetic Resonance Imaging: Implications for Biceps Tenodesis. Am J Sports Med 2021; 49:346-352. [PMID: 33315467 DOI: 10.1177/0363546520976630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biceps tenodesis is a common treatment for proximal long head of biceps (LHB) tendon pathology. To maintain biceps strength and contour and minimize cramping, restoration of muscle-length tension and appropriate positioning of the tenodesis is key. Little is known about the biceps musculotendinous junction (MTJ) anatomy, especially in relation to the overlying pectoralis major tendon (PMT), which is a commonly used landmark for tenodesis positioning. PURPOSE To characterize the in vivo topographic anatomy of the LHB tendon, in particular the MTJ relative to the PMT, using a novel axial proton-density magnetic resonance imaging (MRI) sequence. STUDY DESIGN Descriptive laboratory study. METHODS In total, 45 patients having a shoulder MRI for symptoms unrelated to their biceps tendon or rotator cuff were prospectively recruited. There were 33 men and 12 women, with a mean age of 37 ± 13 years (range, 18-59 years). All patients underwent routine shoulder MRI scans with an additional axial proton density sequence examining the LHB tendon and its MTJ. Three independent observers reviewed each MRI scan, and measurements were obtained for (1) MTJ length, (2) the distance between the proximal MTJ and the superior border of the PMT (MTJ-S), (3) the distance between the distal MTJ to the inferior border of the PMT, and (4) the width of the PMT. RESULTS The average position of the MTJ-S was 5.9 ± 10.8 mm distal to the superior border of the PMT. The mean MTJ length was 32.5 ± 8.3 mm and the width of the PMT was 28.0 ± 7.3 mm. We found no significant correlation between patient age, height, sex, or body mass index and any of the biceps measurements. We observed wide variability of the MTJ-S position and identified 3 distinct types of biceps MTJ: type 1, MTJ-S above the PMT; type 2, MTJ-S between 0 and 10 mm below the superior border of the PMT; and type 3, MTJ-S >10 mm distal to the superior PMT. CONCLUSION In this study, the in vivo anatomy of the LHB tendon is characterized relative to the PMT using a novel MRI sequence. The results demonstrate wide variability in the position of the MTJ relative to the PMT, which can be classified into 3 distinct subtypes or zones relative to the superior border of the PMT. Understanding this potentially allows for accurate and anatomic placement of the biceps tendon for tenodesis. CLINICAL RELEVANCE To our knowledge, this is the first study to radiologically analyze the in vivo topographic anatomy of the LHB tendon and its MTJ. The results of this study provide more detailed understanding of the variability of the biceps MTJ, thus allowing for more accurate placement of the biceps tendon during tenodesis.
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Affiliation(s)
- Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Philpott
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nada Richards
- Victoria House Medical Imaging, Melbourne, Victoria, Australia
| | - Andrew J Hardidge
- Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ayla D Wood
- Department of Orthopaedic Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Zhou P, Liu J, Deng X, Li Z. Biceps tenotomy versus tenodesis for lesions of the long head of the biceps tendon: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e23993. [PMID: 33545991 PMCID: PMC7837917 DOI: 10.1097/md.0000000000023993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Biceps tenotomy and biceps tenodesis are 2 most common surgical procedures for long head of the biceps tendon (LHBT) pathology, but debate still exists regarding the choice of treatment. This meta-analysis was conducted to compare clinical results between tenotomy and tenodesis for the treatment of lesions of LHBT. It was hypothesized that there is no difference in outcomes of tenotomy and tenodesis for lesions of LHBT. METHODS A comprehensive search of literature published between 1980 and April 2020 was performed using MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. Randomized controlled trials (RCTs) comparing tenotomy and tenodesis for LHBT lesions were included. The primary outcomes were Constant score and Popeye deformity. The secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, muscle strength, cramping pain, and operative time. For primary outcomes, trial sequential analysis (TSA) was conducted to reduce the risk of random errors and the GRADE (grading of recommendations, assessment, development, and evaluations) approach was used to assess the quality of the body of evidence. RESULTS A total of 9 RCTs were included. In pooled analysis, statistical significance was observed in the Constant score (mean difference [MD], 1.59; 95% confidence interval [CI] 0.04-3.14; P = .04), Popeye deformity (risk ratio [RR], 0.33; 95% CI, 0.22-0.49; P < .00001) and operative time (MD, 9.94; 95% CI 8.39-11.50; P < .00001). However, there were no significant differences between the tenodesis and tenotomy in ASES score (P = .71), VAS for pain (P = .79), cumulative elbow flexion strength (P = .85), cumulative elbow supination strength (P = .23), and cramping pain (P = .61) TSA revealed that the results for Constant score was inconclusive. CONCLUSION For the treatment of LHBT lesions, with the exception of constant score, there was no significant benefit of tenodesis over tenotomy. Although tenotomy is affected by a higher risk of Popeye sign, it is more timesaving.
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Affiliation(s)
- Peng Zhou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan ProvincialLaboratory of Orthopaedic Engineering, Lu Zhou, Si Chuan Province
| | - Juncai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan ProvincialLaboratory of Orthopaedic Engineering, Lu Zhou, Si Chuan Province
| | - Xiangtian Deng
- School of Medicine, Nankai University, Tianjin, P.R. China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University
- Sichuan ProvincialLaboratory of Orthopaedic Engineering, Lu Zhou, Si Chuan Province
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Erdle NJ, Osier CJ, Hammond JE. Humerus Fractures After Open Subpectoral Biceps Tenodesis: Three Cases with 2-year Functional Outcome Data and Review of the Literature. JBJS Case Connect 2021; 10:e0033. [PMID: 31899721 DOI: 10.2106/jbjs.cc.19.00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The authors present 3 cases of humerus fracture after biceps tenodesis performed by 3 different surgeons with radiographs and outcome scores with a minimum of 30 months follow-up. Fractures occurred between 7 days and 4 months postoperatively and include 2 fractures where tenodesis had been performed with interference screw fixation and one fracture where tenodesis had been performed with a bicortical endobutton technique. CONCLUSIONS These case reports highlight the risk of this complication in biceps tenodesis with bony fixation. The authors review the previously reported cases and relevant biomechanical studies that elucidate risk factors for humerus fracture and discuss alternative means to treat biceps tendon pathology.
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Affiliation(s)
- Nicholas J Erdle
- Department of Orthopaedic Surgery, Naval Medical Center, Portsmouth, Virginia
| | - Charles J Osier
- Department of Orthopaedic Surgery, Naval Medical Center, Portsmouth, Virginia
| | - James E Hammond
- Department of Orthopaedic Surgery, Naval Medical Center, Portsmouth, Virginia
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38
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Cao MD, Song YC, Lu HD. Letter to the Editor regarding Anil et al: "Surgical treatment for long head of the biceps tendinopathy: a network meta-analysis". J Shoulder Elbow Surg 2021; 30:e34-e35. [PMID: 32956776 DOI: 10.1016/j.jse.2020.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/13/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Ming-De Cao
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Yan-Cheng Song
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China; Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hua-Ding Lu
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.
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Lei L, Zhang C, Sun FH, Xie Y, Liang B, Wang L, Pang G, Chen R, Jiang W, Ou X, Miyamoto A, Wang J. Research Trends on the Rotator Cuff Tendon: A Bibliometric Analysis of the Past 2 Decades. Orthop J Sports Med 2021; 9:2325967120973688. [PMID: 33553446 PMCID: PMC7829523 DOI: 10.1177/2325967120973688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical research on the rotator cuff tendon is increasing, and new approaches are being applied to rotator cuff disease. Considering the integration of research resources and research trends, it is necessary to conduct an analysis of recent research on the topic. PURPOSE To identity the research trends, influential journals, key researchers, and core countries of rotator cuff tendon research between 2000 and 2019. STUDY DESIGN Cross-sectional study. METHODS All the literature related to rotator cuff tendon research was retrieved from the Web of Science Core Collection on January 7, 2020. Qualitative and quantitative analyses were processed based on Web of Science and CiteSpace. RESULTS A total of 4131 studies, which included 3830 articles and 301 reviews, were obtained. There was an upward trend of studies on the topic, with small fluctuations in the past 2 decades. The United States had the most studies, and the number of studies from other countries increased over the study period. Most of the funding sources came from the United States. Articles in the Journal of Shoulder and Elbow Surgery had the most citations for rotator cuff research. Frontier topics, such as arthroscopic repair, mesenchymal stem cell, and "platelet-rich plasma, were identified. The number of citations in 2018 (r = 0.280; P = .005) and 2019 (r = 0.307; P = .002) had a weak positive correlation with publication date, indicating that the more recently published articles had a higher number of citations. CONCLUSION Valuable information on rotator cuff research based on bibliometric analysis was identified. Arthroscopic repair, mesenchymal stem cell, and platelet-rich plasma might be the research frontiers in this field, and researchers should focus on these topics in future studies.
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Affiliation(s)
- Lei Lei
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
| | - Chi Zhang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
- Nuclear Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Fu-Hua Sun
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
| | - Yujie Xie
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
| | - Bin Liang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
| | - Li Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
| | - Guoyin Pang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
| | - Ruyan Chen
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
| | - Wei Jiang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
| | - Xia Ou
- Nuclear Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Akira Miyamoto
- Department of Physical Therapy Faculty of Rehabilitation of Kobe
International University, Japan
| | - Jianxiong Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan, People’s Republic of China
- Rehabilitation Medicine Department, The Southwest Medical
University, Luzhou, Sichuan, People’s Republic of China
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Ji X, Ye L, Hua Y, Zhou X. Rotator Cuff Repair Improves Clinical Function and Stability in Patients Older Than 50 Years With Anterior Shoulder Dislocations and Massive Rotator Cuff Tears. Orthop J Sports Med 2020; 8:2325967120969213. [PMID: 33403216 PMCID: PMC7747109 DOI: 10.1177/2325967120969213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Older patients with shoulder instability have a higher prevalence of rotator
cuff tears and anterior capsular lesions. Simultaneous rotator cuff repair
and labral repair are commonly performed to improve shoulder stability and
function. Purpose: To investigate the clinical outcomes of arthroscopic rotator cuff repair for
older patients with shoulder dislocations combined with massive rotator cuff
tears and intact labral tissue. Study Design: Case series; Level of evidence, 3. Methods: A cohort consisting of 11 patients older than 50 years with shoulder
dislocations and massive rotator cuff tears undergoing arthroscopic rotator
cuff repair was identified between December 2015 and January 2018. Rotator
cuff repair was performed after Bankart, superior labral anterior-posterior,
and humeral avulsion of the glenohumeral ligament lesions were excluded
during arthroscopic surgery. Preoperative and 12-month postoperative
outcomes including modified University of California Los Angeles (UCLA),
American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder
Instability Index (WOSI), and visual analog scale for pain scores as well as
range of motion (ROM) were recorded. Results: The supraspinatus tendon was torn in all patients. Also, 36.4% of the
patients had 3 rotator cuff tendons torn. For shoulder function, the
preoperative UCLA score (12.1 ± 2.5 [range, 9-16]) and ASES score (35.4 ±
12.7 [range, 24-44]) significantly improved to 29.4 ± 4.3 (range, 24-35;
P < .001) and 79.4 ± 16.0 (range, 45-95;
P < .001), respectively, at 12 months
postoperatively. None of the patients experienced shoulder redislocations at
12 months after surgery. For shoulder stability, the postoperative WOSI
score (156.8 ± 121.0 [range, 45-365]) was significantly better than was the
preoperative score (713.0 ± 238.6 [range, 395-1090]) (P
< .001). For comparisons between preoperative and postoperative ROM,
forward flexion, abduction, and external and internal rotation at the side
significantly improved. Conclusion: For patients older than 50 years with shoulder dislocations combined with
massive rotator cuff tears and an intact labrum, arthroscopic rotator cuff
repair alone achieved satisfactory functional outcomes and ROM without the
recurrence of dislocations.
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Affiliation(s)
- Xiaoxi Ji
- Huashan Hospital, Fudan University, Shanghai, China
| | | | - Yinghui Hua
- Huashan Hospital, Fudan University, Shanghai, China
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41
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Toale JP, Hurley ET, Davey MS, Cassidy JT, Pauzenberger L, Mullett H. Return to Play after Arthroscopic Bankart Repair Combined with Open Subpectoral Biceps Tenodesis. Arthrosc Sports Med Rehabil 2020; 2:e499-e503. [PMID: 33134986 PMCID: PMC7588640 DOI: 10.1016/j.asmr.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/21/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To evaluate the clinical outcomes and rate of return to play (RTP) in patients who underwent arthroscopic Bankart repair and open subpectoral biceps tenodesis. Methods A retrospective review of patients who underwent combined arthroscopic Bankart repair and open subpectoral biceps tenodesis by a single surgeon between 2012 and 2016 was performed. RTP, the level of return, and the timing of return were assessed. Visual analog scale for pain, Rowe score, Shoulder Instability-Return to Sport after Injury score, and Subjective Shoulder Value were evaluated. Results The study included 14 patients, with a mean follow-up of 34.2 ± 12.1 months. Of the 14 patients, 13 (92.9%) returned to sport at a mean of 4.8 ± 1.2 months and 9 (64.3%) returned to the same or higher level of sport. At final follow-up, the mean Rowe was 80.0 ± 16.3, the mean Subjective Shoulder Value was 81.0 ± 15.1, the mean Shoulder Instability-Return to Sport after Injury was 57.3 ± 25.6, and the mean visual analog scale score was 2.6 ± 1.5. One patient had a recurrent dislocation, whereas no patients underwent a further operation on the ipsilateral shoulder. Conclusion Patients undergoing arthroscopic Bankart repair combined with open subpectoral biceps tenodesis had a high rate of RTP with a low rate of recurrent instability. Level of Evidence IV, Therapeutic Case Series.
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Affiliation(s)
- James P. Toale
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T. Hurley
- Sports Surgery Clinic, Dublin, Ireland
- National University of Ireland Galway, Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Address correspondence to Eoghan T. Hurley, M.B., B.Ch., M.Ch., Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.
| | - Martin S. Davey
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J. Tristan Cassidy
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Zalneraitis BH, Milam BP, Turner EK, Gasbarro G, Galvin JW. Biceps Squeeze Tenotomy: Technique to Improve Efficiency of Arthroscopic Biceps Tenotomy. Arthrosc Tech 2020; 9:e1851-e1853. [PMID: 33294351 PMCID: PMC7695749 DOI: 10.1016/j.eats.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/08/2020] [Indexed: 02/03/2023] Open
Abstract
Biceps tenotomy is a common procedure performed in arthroscopic shoulder surgery. Numerous studies have demonstrated the effectiveness of both biceps tenotomy and tenodesis to relieve pain and restore function for the diagnoses of bicipital tenosynovitis, SLAP tears, rotator interval pulley lesions, and failed SLAP repairs. It is also frequently performed as a concomitant procedure with arthroscopic rotator cuff repair. We report a technique to improve the efficiency of arthroscopic bicep tenotomy using a biceps squeeze maneuver. This is a simple method of manually squeezing the biceps muscle belly while performing the arthroscopic biceps tenotomy. This shortens and tensions the intra-articular portion of the tendon to facilitate a more safe and efficient procedure.
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Affiliation(s)
- B. Holt Zalneraitis
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A
| | - Brian P. Milam
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A
| | - Eric K. Turner
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A
| | - Gregory Gasbarro
- The Shoulder, Elbow, Wrist, and Hand Center, Mercy Medical Center, Baltimore, Maryland, U.S.A
| | - Joseph W. Galvin
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A.,Address correspondence to Joseph W. Galvin, Department of Orthopaedics, Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431.
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43
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van Deurzen DFP, Garssen FL, Kerkhoffs GMMJ, Bleys RLAW, Ten Have I, van den Bekerom MPJ. Clinical relevance of the anatomy of the long head bicipital groove, an evidence-based review. Clin Anat 2020; 34:199-208. [PMID: 32379369 DOI: 10.1002/ca.23610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 11/09/2022]
Abstract
Pathology in the bicipital groove can be a source of anterior shoulder pain. Many studies have compared treatment techniques for the long head biceps tendon (LHBT) without showing any clinically significant differences. As the LHBT is closely related to the bicipital groove, anatomical aspects of this groove could also be implicated in surgical outcomes. The aim of this review is to contribute to developing the optimal surgical treatment of LHBT pathology based on clinically relevant aspects of the bicipital groove. Medline/PubMed was systematically searched using key words "bicipital" and "groove" and combinations of their synonyms. Studies reporting on evolution, embryonic development, morphometry, vascularization, innervation, and surgical treatment of the LHBT and the bicipital groove were included. The length of the bicipital groove reported in the included studies ranged from 81.00 mm to 87.33 mm, width from 7.74 mm to 11.60 mm, and depth from 3.70 mm to 6.00 mm. The anatomy of the bicipital groove shows a bottleneck narrowing approximately two-thirds from superior. The transverse humeral ligament can constrain the bicipital groove and could be involved in anterior shoulder pain. When either LHBT tenotomy or tenodesis is performed, routinely releasing the transverse ligament could decrease postoperative anterior shoulder pain, which has frequently been reported in the literature. To avoid the bottle neck narrowing, a location below the bicipital groove may be preferred for biceps tenodesis over a more proximal tenodesis site. Level of evidence: IV.
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Affiliation(s)
- Derek F P van Deurzen
- Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Frans L Garssen
- Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Center (AUMC), Amsterdam Centre for European Studies (ACES) and the Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Isha Ten Have
- Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
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44
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Kim J, Nam JH, Kim Y, Kim JS, Kim SH. Long Head of the Biceps Tendon Tenotomy versus Subpectoral Tenodesis in Rotator Cuff Repair. Clin Orthop Surg 2020; 12:371-378. [PMID: 32904028 PMCID: PMC7449864 DOI: 10.4055/cios19168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/26/2019] [Indexed: 11/08/2022] Open
Abstract
Backgroud Lesions of the long head of the biceps tendon (LHBT) are one of the most common pathologies in patients with a rotator cuff tear. Although various procedures have been shown to be effective for treating LHBT lesions during rotator cuff repair, no consensus has been reached regarding the most effective treatment. The purpose of this study was to compare the outcomes of tenotomy vs subpectoral tenodesis of the LHBT in arthroscopic rotator cuff repair. Methods The records of 135 patients who underwent arthroscopic rotator cuff repair with biceps tenotomy or subpectoral tenodesis for a partial LHBT tear of > 50% were initially reviewed. Finally, 77 patients (38 patients with tenotomy and 39 patients with subpectoral tenodesis) with an intact rotator cuff, who underwent a functional evaluation at 1 year postoperatively, were enrolled in this retrospective study. Results The average follow-up was 13.3 ± 4.36 months (13.2 ± 1.4 months in the tenotomy group and 13.6 ± 2.7 months in the subpectoral tenodesis group; p = 0.416). Demographic and surgical data were not significantly different between the 2 groups. Preoperatively, biceps groove tenderness, Speed's test, and Yergason test results were positive in 27.3%, 27.3%, and 10.4% of the study subjects, respectively. Compared with preoperative values, all functional scores including shoulder muscle power were significantly improved postoperatively, and no significant intergroup difference was observed (all p > 0.05). A visible Popeye deformity was not encountered in either group at the final follow-up. Eight patients in the tenotomy group and 7 patients in the subpectoral tenodesis group complained of mild anterior shoulder pain (p = 0.731), and 4 patients in each group complained of groove tenderness (p = 0.969). No surgical or postoperative complication occurred in either group. Conclusions Both biceps tenotomy and subpectoral tenodesis performed during rotator cuff repair improved pain and function and resulted in comparable clinical outcomes. Residual symptoms associated with the remnant LHBT in the groove may not be a problem after adhesion of LHBT.
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Affiliation(s)
- Jangwoo Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Nam
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yuna Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Seop Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Anil U, Hurley ET, Kingery MT, Pauzenberger L, Mullett H, Strauss EJ. Surgical treatment for long head of the biceps tendinopathy: a network meta-analysis. J Shoulder Elbow Surg 2020; 29:1289-1295. [PMID: 32037231 DOI: 10.1016/j.jse.2019.10.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/19/2019] [Accepted: 10/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical options for pathology affecting the long head of the biceps tendon (LHBT) include tenotomy and tenodesis, both of which can be performed with a variety of fixation methods. This study aimed to compare surgical treatment options for LHBT lesions using a network meta-analysis of published clinical studies. METHODS A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Clinical studies comparing surgical treatment options for LHBT lesions were included. Postoperative outcomes were compared between surgical treatment options using a frequentist approach to network meta-analysis. RESULTS There were 22 studies comparing surgical treatment options for LHBT pathology including arthroscopic tenotomy, arthroscopic suprapectoral tenodesis, arthroscopic intracuff tenodesis, and open subpectoral tenodesis, consisting of 1804 patients. Compared with arthroscopic tenotomy, open subpectoral tenodesis resulted in a significantly greater American Shoulder and Elbow Surgeons score (mean difference, 4.58; P = .014). On the basis of the P-score, all 3 tenodesis techniques ranked above tenotomy with respect to the Constant score. Compared with arthroscopic tenotomy, the incidence of Popeye deformity was reduced with arthroscopic suprapectoral tenodesis (odds ratio [OR], 0.23; P < .001) and open subpectoral tenodesis (OR, 0.25; P = .022). The incidence of bicipital groove pain was increased after arthroscopic intracuff tenodesis (OR, 2.89; P = .021) compared with arthroscopic tenotomy. CONCLUSION Lesions of the LHBT treated with open or arthroscopic tenodesis resulted in comparatively superior functional outcomes and a lower incidence of Popeye deformity, whereas arthroscopic intracuff tenodesis resulted in a higher incidence of bicipital groove pain.
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Affiliation(s)
- Utkarsh Anil
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Eoghan T Hurley
- Department of Trauma and Orthopaedics, Royal College of Surgeons in Ireland, Dublin, Ireland; Sports Surgery Clinic, Dublin, Ireland
| | - Matthew T Kingery
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | | | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
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Hong CK, Chang CH, Hsu KL, Kuan FC, Wang PH, Su WR. Patients older than 55 years prefer biceps tenodesis over tenotomy to the same degree as young patients. J Orthop Sci 2020; 25:416-422. [PMID: 31160159 DOI: 10.1016/j.jos.2019.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND 55 years of age used to be the cutoff point when deciding between biceps tenotomy and tenodesis for treating biceps tendon pathologies. METHODS Patients aged ≥18 years who had tendonitis in the long head of the biceps and were admitted for arthroscopic surgery were included. A questionnaire with a series of questions assessing patients' current symptoms, their concerns about their outcomes, and personal demographic information was introduced to the participants on the day before the surgery. The patients' preference toward tenotomy and tenodesis was assessed, and χ2 tests and logistic regressions were used to test the association with the categorical and ordinal variables, respectively. RESULTS A total of 135 patients enrolled in the study, with 83 males and 52 females, the mean age of which was 56 years (range, 18-75 years). Of all patients, 86 (63.7%) preferred biceps tenodesis as opposed to tenotomy; meanwhile, there was no difference in preference toward tenodesis in each age- and gender-subgroup (range, 55.1% to 71.4%). The different subgroups had specific factors that were predictive of choosing either a tenotomy or tenodesis. In most subgroups, concerns about postoperative arm appearance and the so-called "Popeye" deformity due to tenotomy were factors predictive of choosing biceps tenodesis, whereas concern about longer rehabilitation due to tenodesis was the factor predictive of choosing biceps tenotomy. CONCLUSIONS Biceps tenodesis is a more preferable choice for patients with biceps tendinopathies in all age and gender subgroups. Patients' concerns on postoperative arm appearance, "Popeye" deformity due to tenotomy, and longer rehabilitation due to tenodesis are the most important predictive factors.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chih-Hsun Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
| | - Ping-Hui Wang
- Department of Orthopedics, Chi-Mei Medical Center, Tainan, Taiwan.
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan.
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47
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MacDonald P, Verhulst F, McRae S, Old J, Stranges G, Dubberley J, Mascarenhas R, Koenig J, Leiter J, Nassar M, Lapner P. Biceps Tenodesis Versus Tenotomy in the Treatment of Lesions of the Long Head of the Biceps Tendon in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective Double-Blinded Randomized Controlled Trial. Am J Sports Med 2020; 48:1439-1449. [PMID: 32223645 DOI: 10.1177/0363546520912212] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The biceps tendon is a known source of shoulder pain. Few high-level studies have attempted to determine whether biceps tenotomy or tenodesis is the optimal approach in the treatment of biceps pathology. Most available literature is of lesser scientific quality and shows varying results in the comparison of tenotomy and tenodesis. PURPOSE To compare patient-reported and objective clinical results between tenotomy and tenodesis for the treatment of lesions of the long head of the biceps brachii. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients aged ≥18 years undergoing arthroscopic surgery with intraoperative confirmation of a lesion of the long head of the biceps tendon were randomized. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score, while secondary outcomes included the Western Ontario Rotator Cuff Index (WORC) score, elbow and shoulder strength, operative time, complications, and the incidence of revision surgery with each procedure. Magnetic resonance imaging was performed at postoperative 1 year to evaluate the integrity of the procedure in the tenodesis group. RESULTS A total of 114 participants with a mean age of 57.7 years (range, 34 years to 86 years) were randomized to undergo either biceps tenodesis or tenotomy. ASES and WORC scores improved significantly from pre- to postoperative time points, with a mean difference of 32.3% (P < .001) and 37.3% (P < .001), respectively, with no difference between groups in either outcome from presurgery to postoperative 24 months. The relative risk of cosmetic deformity in the tenotomy group relative to the tenodesis group at 24 months was 3.5 (95% CI, 1.26-9.70; P = .016), with 4 (10%) occurrences in the tenodesis group and 15 (33%) in the tenotomy group. Pain improved from 3 to 24 months postoperatively (P < .001) with no difference between groups. Cramping was not different between groups, nor was any improvement in cramping seen over time. There were no differences between groups in elbow flexion strength or supination strength. Follow-up magnetic resonance imaging at postoperative 12 months showed that the tenodesis was intact for all patients. CONCLUSION Tenotomy and tenodesis as treatment for lesions of the long head of biceps tendon both result in good subjective outcomes but there is a higher rate of Popeye deformity in the tenotomy group. REGISTRATION NCT01747902 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Peter MacDonald
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Fleur Verhulst
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheila McRae
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason Old
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Greg Stranges
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jamie Dubberley
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randy Mascarenhas
- McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - James Koenig
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark Nassar
- Pan Am Clinic and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter Lapner
- Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
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48
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Mirzayan R, McCrum C, Butler RK, Alluri RK. Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon. Orthop J Sports Med 2020; 8:2325967120904361. [PMID: 32166093 PMCID: PMC7052466 DOI: 10.1177/2325967120904361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Controversy exits regarding performing a tenotomy versus a tenodesis of the
long head of the biceps tendon (LHBT). Purpose: To evaluate the complications after arthroscopic tenotomy of the LHBT and
characterize the incidence of cosmetic deformity, cramping, subjective
weakness, and continued anterior shoulder pain (ASP). Additionally, to
identify patient-related factors that may predispose a patient to these
complications. Study Design: Case-control study; Level of evidence, 3. Methods: Records of patients who underwent an arthroscopic LHBT tenotomy at an
integrated health care system under the care of 55 surgeons were
retrospectively reviewed. Exclusion criteria included LHBT tenodesis,
arthroplasty, neoplastic, or fracture surgery; age younger than 18 years;
incomplete documentation of physical examination; or incomplete operative
reports. Characteristic data, concomitant procedures, LHBT morphology, and
postoperative complications were recorded. Patients with and without
postoperative complications—including cosmetic deformity, subjective
weakness, continued ASP, and cramping—were analyzed by age, sex, dominant
arm, body mass index (BMI), smoking status, workers’ compensation status,
and intraoperative LHBT morphology to identify risk factors for developing
these postoperative complications. Results: A total of 192 patients who underwent LHBT tenotomy were included in the
final analysis. Tenotomy was performed with concomitant shoulder procedures
in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and
55% were male. The overall complication rate was 37%. The most common
postoperative complications include cosmetic (Popeye) deformity (14.1%),
subjective weakness (10.4%), cramping (10.4%), and continued postoperative
ASP over the bicipital groove (7.8%). Every 10-year increase in age was
associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and
0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had
3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity.
Patients who had active workers’ compensation claims had 12.5 (95% CI,
2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on
the dominant arm, BMI, and active smoking status demonstrated no
statistically significant association with postoperative complications. Conclusion: Patients experiencing complications after tenotomy were significantly younger
and more likely to be male and to have a workers’ compensation injury. LHBT
tenotomy may best be indicated for elderly patients, female patients, and
those without active workers’ compensation claims.
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Affiliation(s)
- Raffy Mirzayan
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, California, USA
| | - Christopher McCrum
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Rebecca K Butler
- Department of Biostatistics, Programming and Research Database Services, Kaiser Permanente, Pasadena, California, USA
| | - Ram Kiran Alluri
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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49
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Aflatooni JO, Meeks BD, Froehle AW, Bonner KF. Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction. J Orthop Surg Res 2020; 15:56. [PMID: 32070381 PMCID: PMC7029563 DOI: 10.1186/s13018-020-1581-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/05/2020] [Indexed: 11/15/2022] Open
Abstract
Background Biceps tenotomy and tenodesis are surgical treatments for pathology of the proximal tendon of the long head of the biceps. There is debate over which procedure provides better patient outcomes. Purpose Compare patient-reported outcomes and satisfaction between biceps tenotomy and tenodesis. Methods This retrospective cohort study including all patients undergoing arthroscopic biceps tenodesis or tenotomy as part of more extensive shoulder surgery with a single surgeon. Concomitant procedures included rotator cuff repair, subacromial decompression, acromioclavicular joint resection, and debridement. Patients 36–81 years old were contacted by phone at > 2-year post-operatively to complete a biceps-specific outcome questionnaire. Subject decision not to participate was the sole exclusion criterion. Satisfaction scores and frequencies of potential biceps-related downsides (biceps cramping/spasms, biceps pain, shoulder pain, weakness, cosmetic deformity) were analyzed for the effects of procedure, sex, and age. Results Satisfaction score distributions were similar between patients with tenodesis and patients with tenotomy (χ2 = 8.34, P = 0.08), although slightly more patients with tenodesis than patients with tenotomy reported being satisfied or very satisfied (96% versus 91%). Perceived downsides occurred more frequently among patients with tenotomy than in patients with tenodesis: 59% of patients with tenotomy reported ≥ 1 downside, versus 37% of patients with tenodesis (P < 0.01). In patients reporting ≥ 1 downside, distributions of total downsides differed between procedures (χ2 = 10.04, P = 0.04): patients with tenotomy were more likely to report multiple concurrent downsides than were patients with tenodesis (31% versus 16%). Each individual downside tended to be reported as present by a greater proportion of patients with tenotomy than patients with tenodesis. Sex had no effect on satisfaction or downsides, but there was a trend for older patients to report higher satisfaction and fewer downsides. Conclusions Biceps tenotomy and tenodesis are both viable treatments for proximal biceps tendon pathology, yielding high patient satisfaction. There were trends toward greater satisfaction and fewer problems in patients with tenodesis. Still, younger patients with tenodesis did report perceived downsides. Alternatively, older patients tended to be more satisfied with both procedures overall. Regardless of procedure, most patients receiving either tenotomy or tenodesis would undergo their respective surgery again. Level of Evidence Level III evidence, retrospective comparative cohort study
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Affiliation(s)
| | - Brett D Meeks
- Department of Orthopaedic Surgery, Wright State University, Dayton, OH, USA
| | - Andrew W Froehle
- Department of Orthopaedic Surgery, Wright State University, Dayton, OH, USA
| | - Kevin F Bonner
- Jordan-Young Institute, Orthopaedic Surgery and Sports Medicine, Virginia Beach, VA, USA
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50
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Meghpara M, Schulz W, Golan E, Vyas D. All-Arthroscopic Biceps Tenodesis Using the Anterolateral Anchor During Concomitant Double-Row Rotator Cuff Repair. Arthrosc Tech 2020; 9:e85-e89. [PMID: 32021779 PMCID: PMC6993188 DOI: 10.1016/j.eats.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/02/2019] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic biceps tenodesis is a commonly performed procedure; however, there is a paucity of literature regarding concomitant biceps tenodesis and double-row rotator cuff repair. In this Technical Note, we describe an all-arthroscopic biceps tenodesis using the stay sutures from the anterolateral anchor in the setting of a double-row rotator cuff repair. The anterolateral anchor is placed adjacent to the bicipital groove to accommodate the tenodesis. Two sutures loaded into the anterolateral anchor are passed through the long head of the biceps tendon in a cinch configuration without the need to externalize the tendon. The sutures are tied arthroscopically, thereby securing the tendon to the anterolateral row anchor and completing the tenodesis.
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Affiliation(s)
- Mitchell Meghpara
- UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, U.S.A
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