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Kim YT, Lee KJ, Kim SH. Biceps Rerouting Regardless of a Biceps-Labral Lesion During Rotator Cuff Repair Results in Lower Retear Rates and Comparable Clinical Outcomes to Subpectoral Biceps Tenodesis. Arthroscopy 2024; 40:2162-2170. [PMID: 38311266 DOI: 10.1016/j.arthro.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To evaluate the radiographic and clinical outcomes when rerouting a pathologic biceps during arthroscopic rotator cuff repair by comparing it with concomitant subpectoral biceps tenodesis (SPBT). METHODS This retrospective, historical cohort study was conducted with patients who underwent an arthroscopic repair of a full-thickness rotator cuff tear, with intraoperative confirmation of biceps pathology including partial tears, subluxation, pulley lesions, or type II SLAP lesions. Until May 2018, such patients were treated with concomitant subpectoral tenodesis (group SPBT). Afterward, biceps rerouting (BR) was done regardless of biceps pathology (group BR) without biceps or SLAP repair. Radiographic parameters, including fatty degeneration, acromiohumeral distance, Sugaya classification, and retears, were evaluated using preoperative and 1-year postoperative magnetic resonance imaging results. Clinical evaluation with a minimum 2-year follow-up included pain visual analog scale, American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Constant-Murley scores. Whether individual patients exceeded these scores' minimal clinically important difference also was determined. RESULTS A total of 64 patients (group SPBT = 32; group BR = 32) were included in the final analysis. The duration of clinical follow-up was 36.2 ± 9.3 months in group SPBT and 29.4 ± 6.9 months in the BR group (P = .002). Compared with group SPBT, group BR demonstrated a significantly lower retear rate (SPBT vs BR: 34.4% vs 12.5%, P = .039). In the BR group, 8 of 32 (25%) patients demonstrated a postoperative LHBT tear. The 4 cuff retears in group BR only took place within these patients. Other postoperative radiographic and clinical outcomes were comparable between the groups. Within each group, significant postoperative improvements were demonstrated (P < .05 for all clinical scores). CONCLUSIONS Even in the presence of a pathologic LHBT and/or a type II SLAP lesion, augmenting the rotator cuff repair with BR significantly reduced retear rates while achieving clinical scores comparable with SPBT in a minimum 2-year follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Yong Tae Kim
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi, Korea
| | - Kyung Jae Lee
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Sae Hoon Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea.
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Poff GW, Broyles J, Mashburn C, Shore S, Spencer EE. Novel all-arthroscopic biceps tenodesis technique incorporated into rotator cuff repair-two hundred cases with minimum 2-year follow-up. JSES Int 2024; 8:459-463. [PMID: 38707557 PMCID: PMC11064578 DOI: 10.1016/j.jseint.2023.07.008] [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: 05/07/2024] Open
Abstract
Background Biceps tendon pathology is a common source of pain in the shoulder. It is frequently seen in conjunction with symptomatic rotator cuff tears. Biceps tendon management during arthroscopic rotator cuff repairs can be achieved via tenodesis with various techniques or tenotomy. Tenodesis of the biceps generally results in less deformity and reduced exertion-related cramping. However, most techniques require the addition of some type of hardware to provide fixation for the biceps tendon, which adds cost, time, and complexity. This study presents a technique for an all-arthroscopic bicep tenodesis performed in conjunction with a double-row rotator cuff repair, requiring no additional hardware. Methods This study is a retrospective review of data that were prospectively collected for 200 consecutive patients for whom the procedure was performed. Patients were seen postoperatively at 2 weeks, 6 weeks, 4 months, and 6 months and in addition massive rotator cuff repairs were seen at 8 months. Additionally all patients were contacted at a minimum 2-year follow-up to access for the presence deformity, the American Shoulder and Elbow Surgeons (ASES) score, and SANE score. Descriptive statistics and comparisons to known minimal clinical important differences (MCIDs) for the patient recorded outcome measures were recorded. Results Two hundred patients were included in the study and 152 responded to the telephone interviews. The mean age of the patients at the time of surgery was 65.3 year old (standard deviation ± 9.1, range of 46-84), and the mean postoperative phone interview was 3.2 years postsurgery (standard deviation of ± 1.0, range of 2-5 years). The average ASES score improved from 52.6 to 94.6, which is 3 times greater than the minimal clinical important difference. The average postoperative SANE score was 94. Seven procedures out of the 200 were labeled as failures due to 1 patient's nonsatisfaction with the procedure and 3 for a Popeye deformity and 3 that had a revision RCR. Discussion The described method of an arthroscopic biceps tenodesis performed with a rotator cuff repair uses no extra hardware, requires minimal additional operative time, and is clinically effective. At a minimum 2-year follow-up, the all-arthroscopic biceps tenodesis in conjunction with a double-row rotator cuff repair resulted in a marked improvement in their ASES score with a 3.5% failure rate. Conclusion The all-arthroscopic bicep tenodesis performed in conjunction with a double-row rotator cuff repair demonstrated improved clinical outcome, without requiring any additional hardware to tenodese the biceps, at a minimum 2-year follow-up.
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Affiliation(s)
- Grayson W. Poff
- Knoxville Orthopedic Clinic, Shoulder and Elbow Division, Knoxville, TN, USA
| | - John Broyles
- Knoxville Orthopedic Clinic, Shoulder and Elbow Division, Knoxville, TN, USA
| | - Cooper Mashburn
- Knoxville Orthopedic Clinic, Shoulder and Elbow Division, Knoxville, TN, USA
| | - Spencer Shore
- Knoxville Orthopedic Clinic, Shoulder and Elbow Division, Knoxville, TN, USA
| | - Edwin E. Spencer
- Knoxville Orthopedic Clinic, Shoulder and Elbow Division, Knoxville, TN, USA
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Alraddadi A, Aldebasi B, Alnufaie B, Almuhanna M, Alkhalifah M, Aleidan M, Murad Y, Almuklass AM, Ahmed AA. The association between a rotator cuff tendon tear and a tear of the long head of the biceps tendon: Chart review study. PLoS One 2024; 19:e0300265. [PMID: 38466684 PMCID: PMC10927094 DOI: 10.1371/journal.pone.0300265] [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: 09/22/2023] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
Rotator cuff (RC) and long head of the biceps tendon (LHBT) tears are common shoulder problems presented to the orthopedic clinic. The aim of this study was to assess the association between RC and LHBT tears among a Saudi population sample. A total of 243 patients who were diagnosed with shoulder pain due to RC or LHBT tear between 2016 and 2018 using a magnetic resonance imaging scan were included in this study. Females comprised 66% of the sample, and 59% (n = 143) of the shoulders were on the right side. The mean age of the patients was 58 ± 11 years, ranging from 23 to 88 years. A significant association was detected between the LHBT and RC tears (P < 0.001). Out of 26 cases showing RC and LHBT tears, 81% had a full thickness tear, whereas 19% had a partial tear. The LHBT tears were presented significantly in 48% of cases with at least two completely torn RC compared to 10% in cases with one completely torn RC (P < 0.001). The LHBT tear was significantly observed in shoulders with RC tears including the tendons of subscapularis, supraspinatus, and infraspinatus, but not the teres minor (P < 0.001). Both types of tears were presented significantly in senior patients aged more than 65 years compared to younger patients (P < 0.01). Thus, the LHBT should be assessed carefully in shoulders with more than one RC tear or in chronic cases.
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Affiliation(s)
- Abdulrahman Alraddadi
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Bader Aldebasi
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Bander Alnufaie
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Almuhanna
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Alkhalifah
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Motaz Aleidan
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yousef Murad
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Awad M. Almuklass
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Altayeb A. Ahmed
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
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Gadéa F, Dordain F, Merbah J, Charousset C, Berhouet J. Methods to analyse the long head of the biceps in the management of distal ruptures of the supraspinatus tendon. Part 1: the concept of the "biceps box": dynamic rotator interval approach. Incidence of lesions of the long head of the biceps tendon. Orthop Traumatol Surg Res 2023; 109:103669. [PMID: 37517471 DOI: 10.1016/j.otsr.2023.103669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION The area encompassing the long head of the biceps (LHB) can be represented as a rectangular parallelepiped. This geometric view can be likened to a box, the "biceps box", where the sides are the extrinsic structures and the LHB is the intrinsic structure. Since these structures are mobile in relation to each other, a dynamic "biceps box" model can modify assessments of the LHB, in its healthy or pathological state, and make the therapeutic approach to treating LHB lesions less arbitrary. MATERIAL AND METHOD In order to describe the different sides of the "biceps box", and to understand their possible physiological and pathological consequences, a literature review using PRISMA methodology was used. RESULTS The supraspinatus (SSP) has expansions on its anterior aspect that project anteriorly and cross the coracohumeral ligament (CHL). The most functionally important expansion is the fasciculus obliquus, which extends perpendicular to the axis of the tendon fibers of the SSP, divides the CHL into a deep and a superficial layer, and terminates on the superficial aspect of the subscapularis. The humeral insertion of the SSP may be binary, making a bridge over the LHB, with a posterior branch inserting on the greater tuberosity and an anterior branch on the lesser tuberosity. The superior glenohumeral ligament (SGHL) has a twisted course, downward and forward, and ends at the proximal opening of the bicipital groove with a flap on which the LHB rests. The bicipital pulley is not an independent structure but an arciform structure resulting from the fusion of several tissues. DISCUSSION The presence of structures linked together by common expansions in the 3 planes of space validates the relevance of a "biceps box" as a functional geometric model. The structure that acts as a crossroads through which all expansions pass is the CHL. An extrinsic SSP lesion can be compensated for by other "biceps box" structures, whereas an extrinsic SGHL lesion rarely exists without the presence of an intrinsic LHB lesion. The CHL constitutes a connective tissue crossed by a vasculonervous pedicle from the lateral pectoral nerve, which may explain some anterior shoulder pain attributed to the biceps. CONCLUSION The LHB can be likened to an intrinsic structure contained in a box whose sides are made up of different interconnected stabilizing structures defining the extrinsic structures. The concept of a dynamic "biceps box" allows LHB lesions to be accurately classified, separating extrinsic and intrinsic lesions, and thus potentially modifying therapeutic approaches to the LHB. LEVEL OF EVIDENCE IV; systematic review.
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Affiliation(s)
- François Gadéa
- Centre Ortho-Globe, place du Globe, 83000 Toulon, France.
| | - Franck Dordain
- Hôpital privé Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - Johan Merbah
- Centre Ortho-Globe, place du Globe, 83000 Toulon, France
| | | | - Julien Berhouet
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, faculté de médecine, université de Tours Centre-Val de Loire, Tours, France
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Benhenneda R, Brouard T, Dordain F, Gadéa F, Charousset C, Berhouet J. Can artificial intelligence help decision-making in arthroscopy? Part 1: Use of a standardized analysis protocol improves inter-observer agreement of arthroscopic diagnostic assessments of the long head of biceps tendon in small rotator cuff tears. Orthop Traumatol Surg Res 2023; 109:103648. [PMID: 37356800 DOI: 10.1016/j.otsr.2023.103648] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/27/2023]
Abstract
INTRODUCTION Injuries of the long head of biceps (LHB) tendon are common but difficult to diagnose clinically or using imaging. Arthroscopy is the preferred means of diagnostic assessment of the LHB, but it often proves challenging. Its reliability and reproducibility have not yet been assessed. Artificial intelligence (AI) could assist in the arthroscopic analysis of the LHB. The main objective of this study was to evaluate the inter-observer agreement for the specific LHB assessment, according to an analysis protocol based on images of interest. The secondary objective was to define a video database, called "ground truth", intended to create and train AI for the LHB assessment. HYPOTHESIS The hypothesis was that the inter-observer agreement analysis, on standardized images, was strong enough to allow the "ground truth" videos to be used as an input database for an AI solution to be used in making arthroscopic LHB diagnoses. MATERIALS AND METHOD One hundred and ninety-nine sets of standardized arthroscopic images of LHB exploration were evaluated by 3 independent observers. Each had to characterize the healthy or pathological state of the tendon, specifying the type of lesion: partial tear, hourglass hypertrophy, instability, fissure, superior labral anterior posterior lesion (SLAP 2), chondral print and pathological pulley without instability. Inter-observer agreement levels were measured using Cohen's Kappa (K) coefficient and Kappa Accuracy. RESULTS The strength of agreement was moderate to strong according to the observers (Kappa 0.54 to 0.7 and KappaAcc from 86 to 92%), when determining the healthy or pathological state of the LHB. When the tendon was pathological, the strength of agreement was moderate to strong when it came to a partial tear (Kappa 0.49 to 0.71 and KappaAcc from 85 to 92%), fissure (Kappa -0.5 to 0.7 and KappaAcc from 36 to 93%) or a SLAP tear (0.54 to 0.88 and KappaAcc from 90 to 97%). It was low for unstable lesion (Kappa 0.04 to 0.25 and KappaAcc from 36 to 88%). CONCLUSION The analysis of the LHB, from arthroscopic images, had a high level of agreement for the diagnosis of its healthy or pathological nature. However, the agreement rate decreased for the diagnosis of rare or dynamic tendon lesions. Thus, AI engineered from human analysis would have the same difficulties if it was limited only to an arthroscopic analysis. The integration of clinical and paraclinical data is necessary to improve the arthroscopic diagnosis of LHB injuries. It also seems to be an essential prerequisite for making a so-called "ground truth" database for building a high-performance AI solution. LEVEL OF EVIDENCE III; inter-observer prospective series.
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Affiliation(s)
- Rayane Benhenneda
- Service de Chirurgie Orthopédique, Hôpital Trousseau, Faculté de Médecine, Université de Tours Centre-Val de Loire, CHRU de Tours, Tours, France.
| | - Thierry Brouard
- LIFAT (EA6300), École Polytechnique Universitaire de Tours, 64, avenue Jean-Portalis, 37200 Tours, France
| | - Franck Dordain
- Hôpital Privé Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - François Gadéa
- Centre Ortho-Globe, place du Globe, 83000 Toulon, France
| | | | - Julien Berhouet
- Service de Chirurgie Orthopédique, Hôpital Trousseau, Faculté de Médecine, Université de Tours Centre-Val de Loire, CHRU de Tours, Tours, France; LIFAT (EA6300), École Polytechnique Universitaire de Tours, 64, avenue Jean-Portalis, 37200 Tours, France
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Sethi P, Fares MY, Murthi A, Tokish JM, Abboud JA. The long head of the biceps tendon: a valuable tool in shoulder surgery. J Shoulder Elbow Surg 2023; 32:1801-1811. [PMID: 37245621 DOI: 10.1016/j.jse.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 05/30/2023]
Abstract
ANATOMY AND FUNCTION The long head of the biceps tendon (LHBT) has different properties and characteristics that render it a valuable tool in the hands of shoulder surgeons. Its accessibility, biomechanical strength, regenerative capabilities, and biocompatibility allow it to be a valuable autologous graft for repairing and augmenting ligamentous and muscular structures in the glenohumeral joint. SHOULDER SURGERY APPLICATIONS Numerous applications of the LHBT have been described in the shoulder surgery literature, including augmentation of posterior-superior rotator cuff repair, augmentation of subscapularis peel repair, dynamic anterior stabilization, anterior capsule reconstruction, post-stroke stabilization, and superior capsular reconstruction. Some of these applications have been described meticulously in technical notes and case reports, whereas others may require additional research to confirm clinical benefit and efficacy. CONCLUSION This review examines the role of the LHBT as a source of local autograft, with biological and biomechanical properties, in aiding outcomes of complex primary and revision shoulder surgery procedures.
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Affiliation(s)
- Paul Sethi
- Orthopedic and Neurosurgical Specialists, ONS Foundation, Greenwich, CT, USA
| | - Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Anand Murthi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.
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Tang X, Zhang J, Zhang J, He Y. Correlation between the morphological features of the biceps groove and injuries to the biceps pulley and the long head tendon of the biceps. BMC Musculoskelet Disord 2023; 24:377. [PMID: 37173699 PMCID: PMC10176717 DOI: 10.1186/s12891-023-06497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The morphometric features of the biceps groove were measured to investigate their correlation with the injury of the pulley and the long head of the biceps tendon (LHBT). METHODS A total of 126 patients undergoing arthroscopic rotator cuff repair surgery had their morphological features of bicipital groove evaluated on a 3D reconstruction model of the humeral head. The groove width, groove depth, opening angle, medial wall angle, and inclination angle of the bicipital groove were measured for each patient. During the surgery, the type of injury to the biceps pulley and the degree of long head of biceps tendon injury were assessed. The correlations of these injury assessments with bicipital groove measurements were analyzed. RESULTS The average groove width was(12.3 ± 2.1) mm. The average groove depth was(4.9 ± 1.4) mm. The average groove inclination angle was 26.3° ± 8.1°. The average opening angle was 89.8° ± 18.4°. The average medial groove wall angle was 40.6° ± 7.9°.Sixty six patients had injury of the biceps pulley structure, and their Martetschläger classifications were as follows: type I injury in 12 patients, type II injury in 18 patients, and type III injury in 36 patients. The Lafosse grades of Lesions of LHBT were as follows: 72 cases were grade 0 injury, 30 cases were grade I injury, and 24 cases were grade II injury. We found no significant correlation between the opening width, depth, inclination angle, opening angle, and medial wall angle of the morphological features of bicipital groove and injuries of the pulley and the LHBT. The correlation between pulley structure injury and lesions of LHBT was statistically significant. CONCLUSION Lesions of LHBT show strong correlation with pulley injuries.This study does not find a correlation between the injury of the pulley or the LHBT and bicipital groove morphology.
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Affiliation(s)
- Xiaoye Tang
- Department of Orthopaedic Surgery, Guanghua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200052, China
| | - Jialu Zhang
- Department of Orthopaedic Surgery, Guanghua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200052, China
| | - Jiechao Zhang
- Department of Orthopaedic Surgery, Guanghua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200052, China
| | - Yong He
- Department of Orthopaedic Surgery, Guanghua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200052, China.
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Kleim BD, Carbonel JFS, Hinz M, Rupp MC, Scheiderer B, Imhoff AB, Siebenlist S. A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07350-x. [PMID: 36820903 DOI: 10.1007/s00167-023-07350-x] [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: 10/10/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To investigate the influence of intertubercular groove (IG) morphology on the development of different types of biceps reflection pulley (BRP) injuries. METHODS A consecutive cohort of 221 patients with ventral shoulder pain and a preoperative diagnosis suspecting BRP injury, who underwent arthroscopy, was retrospectively reviewed. The presence or absence as well as type of pulley injury (medial, lateral or bilateral) was confirmed arthroscopically. The intertubercular groove was evaluated on MRIs after triplanar reconstruction of the axial plane. IG depth, width, medial wall angle (MWA), lateral wall angle (LWA) and total opening angle (TOA) were measured. IG depth and width were expressed in relation to the humeral head diameter. Measurements were performed by two clinicians independently and averaged. RESULTS Of 166 included patients 43 had bilateral, 65 medial and 38 lateral BRP lesions. 20 patients had intact BRPs and represented the control group. The intra-class correlation coefficient of measurements was 0.843-0.955. Patients with a medial or bilateral BRP injury had a flatter MWA (38.8° or 40.0° vs. 47.9°, p < 0.001), wider TOA (96.1° or 96.6° vs. 82.6°, p < 0.001), greater width (12.5 or 12.3 vs. 10.8 mm, p = 0.013) and shallower depth (5.5 or 5.4 vs. 6.2 mm, p < 0.001) than the control group. Conversely, the IG morphology of those with lateral BRP injuries did not differ significantly from the control group. The odds ratio for a medial or bilateral BRP injury when the TOA exceeded 95° was 6.8 (95% confidence interval 3.04-15.2). CONCLUSION A dysplastic type of IG morphology with a wide TOA, flat MWA, decreased depth and increased width is associated with the presence of medial and bilateral BRP injuries. A TOA of > 95° increases the likelihood of a medial or bilateral BRP injury 6.8-fold. Lateral BRP injuries are not associated with dysplastic IG morphology. Concomitant LHBT surgery may, therefore, not always be necessary during isolated supraspinatus tendon repair. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Benjamin Daniel Kleim
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | | | - Maximilian Hinz
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Balthasar Imhoff
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Graham C, Bergkvist S, Kimball P, Taylor K, Syed M, Mohseni MM. Brachial artery trauma as a complication of bicep muscle injury. Proc (Bayl Univ Med Cent) 2022; 36:126-127. [PMID: 36578592 PMCID: PMC9762816 DOI: 10.1080/08998280.2022.2123662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We describe a rare case of injury to a branch of the brachial artery in a 48-year-old man with a bicep musculotendinous injury. His presenting symptoms included severe pain, swelling, and paresthesias in the right upper extremity. Examination revealed significant soft tissue swelling with ecchymoses in the right upper arm with diminished palpable pulses. Imaging revealed a biceps muscle injury along with active arterial extravasation of a branch of the deep brachial artery. Interventional radiology successfully performed coil embolization. Bicep musculotendinous injury is typically characterized by pain, swelling, and decreased strength. Rarely, complications such as compartment syndrome have been reported. Brachial arterial injury has not been implicated in the setting of this entity, especially in the absence of blunt or penetrating trauma, until our current patient's presentation.
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Affiliation(s)
- Charles Graham
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida
| | - Sarah Bergkvist
- College of Medicine, University of Florida, Gainesville, Florida
| | - Peter Kimball
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida
| | - Katelyn Taylor
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida
| | - Mudassir Syed
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Michael M. Mohseni
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida,Corresponding author: Michael Mohseni, MD, Department of Emergency Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL32224 (e-mail: )
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Srinivasan RC, Hao KA, Wright TW, Farmer KW, Wright JO, Roach RP, Moser MW, Freidl MC, Pazik M, King JJ. Outcomes of Biceps Tenotomy Versus Tenodesis During Arthroscopic Rotator Cuff Repair: An Analysis of Patients From a Large Multicenter Database. Orthop J Sports Med 2022; 10:23259671221110851. [PMID: 35859647 PMCID: PMC9290127 DOI: 10.1177/23259671221110851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Studies to date evaluating biceps tenotomy versus tenodesis in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes. Hypothesis: It was hypothesized that a significant difference could be demonstrated for pain and functional outcome scores comparing biceps tenotomy versus tenodesis in the setting of RCR if the study was adequately powered. Study Design: Cohort study; Level of evidence, 3. Methods: The Arthrex Surgical Outcomes System database was queried for patients who underwent arthroscopic biceps tenotomy or tenodesis and concomitant RCR between 2013 and 2021; included patients had a minimum of 2 years of follow-up. Outcomes between treatment types were assessed using the American Shoulder and Elbow Surgeons Shoulder (ASES), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Results were stratified by age at surgery (3 groups: <55, 55-65, >65 years) and sex. Results: Overall, 1936 primary RCRs were included for analysis (1537 biceps tenodesis and 399 biceps tenotomy patients). Patients who underwent tenotomy were older and more likely to be female. A greater proportion of female patients aged <55 years and 55 to 65 years received a biceps tenotomy compared with tenodesis (P = .012 and .026, respectively). All scores were comparable between the treatment types preoperatively and at 3 months, 6 months, and 1 year postoperatively. At 2-year follow-up, patients who received a biceps tenodesis had statistically more favorable ASES, SANE, VAS pain, and VR-12 scores (P ≤ .031); however, the differences did not exceed the minimal clinically important difference (MCID) for these measures. Conclusion: Our findings indicate that surgeons are more likely to perform a biceps tenotomy in female and older patients. Biceps tenodesis provided improved pain and functional scores compared with tenotomy at 2-year follow-up; however, the benefit did not exceed previously reported MCID for the outcome scores. Both procedures provided improvement in outcomes; thus, the choice of procedure should be a shared decision between the surgeon and patient.
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Affiliation(s)
- Ramesh C Srinivasan
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Ryan P Roach
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Michael W Moser
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Michael C Freidl
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
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11
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Hou Y, Zhang T, Liu W, Lu M, Wang Y. The Effectiveness of Ultrasound-Guided Subacromial-Subdeltoid Bursa Combined With Long Head of the Biceps Tendon Sheath Corticosteroid Injection for Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Front Neurol 2022; 13:899037. [PMID: 35775042 PMCID: PMC9237414 DOI: 10.3389/fneur.2022.899037] [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: 03/18/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Subacromial-subdeltoid (SASD) bursa and long head of the biceps tendon (LHBT) sheath corticosteroid injection are commonly used to treat shoulder pain associated with arthritic shoulder conditions, but effectiveness in the stroke population is unclear. This study aimed to investigate the clinical effectiveness of ultrasound-guided SASD bursa combined with LHBT sheath corticosteroid injection for hemiplegic shoulder pain (HSP) compared with SASD bursa injection alone. Methods 60 patients with HSP were randomly allocated to the dual-target group (n = 30) and single-target group (n = 30). The single-target group received SASD bursa corticosteroid injection alone, and the dual-target group received SASD bursa and LHBT sheath corticosteroid injection. The primary endpoint was pain intensity measured on a visual analog scale (VAS). The secondary endpoint was passive range of motion (PROM) of the shoulder, Upper Extremity Fugl-Meyer assessment (UEFMA) score, and Modified Barthel Index (MBI) score. PROM and pain intensity VAS were assessed at baseline and weeks 1, 4, and 12 post-treatment. UEFMA and MBI were recorded at baseline and weeks 4 and 12 post-treatment. Results A total of 141 patients with HSP were screened, and 60 patients were included. Significant differences in the VAS, PROM, UEFMA and MBI were observed at all follow-ups in both groups. The dual-target group showed a significant difference in VAS score compared with the single-target group (3.3 vs. 3.7, p = 0.01) at week 4 and week 12 (2.5 vs. 3.2, p < 0.001). Moreover, the dual-target group showed statistically significant differences in flexion (p < 0.001) at week 12, extension rotation (p < 0.001) at week 12, and abduction at week 1 (p = 0.003) and weeks 4 and 12 (p < 0.001) compared with the single-target group. There were significant differences in FMA and MBI scores in the two groups before and after treatment (p < 0.001), with a more significant increase in the dual-target group compared with the single-target group (p < 0.001) at week 12. Conclusion The combination of SASD bursa and LHBT sheath corticosteroid injection is superior to SASD bursa injection alone in reducing shoulder pain and improving functional activities in patients with HSP. Clinical Trial Registration www.chictr.org.cn, Unique identifier: ChiCTR2100047125.
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Affiliation(s)
- Yajing Hou
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Wei Liu
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Minjie Lu
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yong Wang
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yong Wang
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12
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Xu J, Han K, Su W, Zhao J. Arthroscopic Biceps Tenotomy Using a Single Portal for Working and Viewing: A Rabbit Model and Technique. Arthrosc Tech 2022; 11:e983-e988. [PMID: 35782833 PMCID: PMC9243671 DOI: 10.1016/j.eats.2022.01.019] [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: 12/22/2021] [Accepted: 01/31/2022] [Indexed: 02/03/2023] Open
Abstract
Biceps tenotomy (BT) is a common surgery used to address anterior shoulder pain and joint dysfunction in humans. Using animal models to simulate human conditions is an effective and essential research strategy to further understand histologic and biomechanical processes that occur after BT, including the pathology of the detached biceps, secondary tendinopathic conditions of the rotator cuffs, and glenohumeral functional changes. This Technical Note presents a comprehensive step-by-step description of an arthroscopic BT procedure in rabbits. This technique is particularly beneficial, as the mini-invasive arthroscopic technique in a rabbit model is similar to that performed in humans. which resulted in less scarring and injuries to other adjacent structures in comparison with open surgery.
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Affiliation(s)
- Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China,Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Rd., Shanghai, China.
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13
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Requejo-Salinas N, Lewis J, Michener LA, La Touche R, Fernández-Matías R, Tercero-Lucas J, Camargo PR, Bateman M, Struyf F, Roy JS, Jaggi A, Uhl T, Bisset L, Wassinger CA, Donatelli R, Haik MN, Lluch-Girbés E. International physical therapists consensus on clinical descriptors for diagnosing rotator cuff related shoulder pain: A Delphi study. Braz J Phys Ther 2022; 26:100395. [PMID: 35366589 DOI: 10.1016/j.bjpt.2022.100395] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There is a lack of standardized criteria for diagnosing rotator cuff related shoulder pain (RCRSP). OBJECTIVE To identify the most relevant clinical descriptors for diagnosing RCRSP. METHODS A Delphi study was conducted through use of an international physical therapists expert panel. A 3-round Delphi survey involving an international panel of physical therapists experts with extensive clinical, teaching, and research experience was conducted. A search query was performed in Web of Science, along with a manual search, to find the experts. The first round was composed of items obtained from a previous pilot Delphi study along with new items proposed by the experts. Participants were asked to rate items across six clinical domains using a five-point Likert scale. An Aiken's Validity Index ≥ 0.7 was considered indicative of group consensus. RESULTS Fifteen experts participated in the Delphi survey. After the three rounds, consensus was reached on 18 clinical descriptors: 10 items were included in the "subjective examination" domain, 1 item was included in the "patient-reported outcome measures" domain, 3 items in the "diagnostic examination" domain, 2 items in the "physical examination" domain", and 2 items in the "functional tests" domain. No items reached consensus within the "special tests" domain. The reproduction of symptoms in relation to the application of load, the performance of overhead activities, and the need of active and resisted movement assessment were some of the results with greatest consensus. CONCLUSION In this Delphi study, a total of 18 clinical descriptors across six clinical domains were agreed upon for diagnosing RCRSP.
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Affiliation(s)
- Néstor Requejo-Salinas
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV). Superior Center for University Studies La Salle. Autonomous University of Madrid, Madrid, Spain
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, United Kingdom; Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, United States
| | - Roy La Touche
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV). Superior Center for University Studies La Salle. Autonomous University of Madrid, Madrid, Spain; Neuroscience and Craniofacial Pain Institute (INDCRAN), Madrid, Spain
| | - Rubén Fernández-Matías
- Research Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain; Research Institute of Physical Therapy and Pain, University of Alcala, Alcala de Henares, Madrid, Spain.
| | | | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Marcus Bateman
- Derby Shoulder Unit, Orthopaedic Outpatient Department, Royal Derby Hospital, Derby, United Kingdom
| | - Filip Struyf
- Department Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada
| | - Anju Jaggi
- Royal National Orthopaedic Hospital NHS Trust, London Borough of Harrow, London, United Kingdom
| | - Timothy Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, United States
| | - Leanne Bisset
- School of Allied Health Sciences, Griffith University, South East Queensland, Australia
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, Tennessee, United States
| | | | - Melina Nevoeiro Haik
- Department of Physical Therapy, Center of Health and Sport Science, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Enrique Lluch-Girbés
- Department of Physical Therapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group, University of Valencia, Valencia, Spain
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14
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Xu J, Li Y, Zhang X, Han K, Ye Z, Wu C, Jiang J, Yan X, Su W, Zhao J. The Biomechanical and Histological Processes of Rerouting Biceps to Treat Chronic Irreparable Rotator Cuff Tears in a Rabbit Model. Am J Sports Med 2022; 50:347-361. [PMID: 35020529 DOI: 10.1177/03635465211062914] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recently, the biceps was rerouted into a newly fabricated bicipital groove for in situ superior capsular reconstruction (SCR), resulting in promising time-zero cadaveric and clinical outcomes. However, no studies have determined the in vivo biomechanical and histological processes after the biceps is transposed to a nonanatomic position. PURPOSE To explore the in vivo biomechanical and histological processes of the rerouting biceps tendon to treat chronic irreparable rotator cuff tears (IRCTs) in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS A total of 94 skeletally mature male rabbits were used to create a chronic IRCT model in the supraspinatus tendon. Then, the biceps rerouting procedures were performed in rabbits with chronic IRCT. Eighteen rabbits were sacrificed at 1, 3, 6, 9, and 12 weeks postoperatively for biomechanical testing, micro-computed tomography scanning, and histological analysis. The biomechanical and histological changes of intra- and extra-articular portions of the rerouting biceps were evaluated at each time point, with the contralateral native superior capsule (NSC) and the native biceps (NB) as controls, respectively. The morphology and bone formation of the fabricated bicipital grooves were evaluated, with native grooves as controls. RESULTS The intra-articular rerouting biceps tendon was progressively remodeled over time, displaying denser fibers and more mature collagen than those of the NSC, with gradual improvements in the tendon-to-bone healing interface from 6 to 12 weeks. Consequently, the failure load and stiffness of the intra-articular rerouting biceps portion increased with time and were significantly higher than those of the NSC from 9 weeks. Similarly, the extra-articular portion of the rerouting biceps progressively healed into a new bicipital groove, as demonstrated by a smaller tendon-to-bone interface from 6 to 12 weeks, resulting in greater failure load and stiffness at 9 and 12 weeks than those of the NB attachment. The newly fabricated bicipital groove showed similar morphology to that of the native groove with sufficient trabecular bone formed underneath. CONCLUSION The rerouting biceps could progressively remodel and heal into the newly fabricated bicipital groove over time, resulting in greater biomechanical performances in intra- and extra-articular portions than the NSC and the NB attachment. CLINICAL RELEVANCE The biceps rerouting technique may be a feasible procedure to perform in situ SCR to treat IRCT in the future clinical practice; however, more clinical evidence is required.
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Affiliation(s)
- Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yufeng Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xueying Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaoyu Yan
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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15
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Colbath G, Murray A, Siatkowski S, Pate T, Krussig M, Pill S, Hawkins R, Tokish J, Mercuri J. Autograft Long Head Biceps Tendon Can Be Used as a Scaffold for Biologically Augmenting Rotator Cuff Repairs. Arthroscopy 2022; 38:38-48. [PMID: 34126215 PMCID: PMC8665938 DOI: 10.1016/j.arthro.2021.05.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We create a viable, mechanically expanded autograft long head biceps tendon (LHBT) scaffold for biologically augmenting the repair of torn rotator cuffs. METHODS The proximal aspect of the tenotomized LHBTs was harvested from patients during rotator cuff repair surgery and was mechanically formed into porous scaffolds using a surgical graft expander. LHBT scaffolds were evaluated for change in area, tensile properties, and tenocyte viability before and after expansion. The ability of endogenous tenocytes derived from the LHBT scaffold to promote tenogenic differentiation of human adipose-derived mesenchymal stromal cells (ADMSCs) was also determined. RESULTS Autograft LHBTs were successfully expanded using a modified surgical graft expander to create a porous scaffold containing viable resident tenoctyes from patients undergoing rotator cuff repair. LHBT scaffolds had significantly increased area (length: 24.91 mm [13.91, 35.90] × width: 22.69 mm [1.87, 34.50]; P = .011) compared with the native LHBT tendon (length: 27.16 mm [2.70, 33.62] × width: 6.68 mm [5.62, 7.74]). The structural properties of the autograft were altered, including the ultimate tensile strength (LHBT scaffold: .56 MPa [.06, 1.06] vs. native LHBT: 2.35 MPa [1.36, 3.33]; P = .002) and tensile modulus (LHBT scaffold: 4.72 MPa [-.80, 1.24] versus native LHBT: 37.17 MPa [24.56, 49.78]; P = .001). There was also a reduction in resident tenocyte percent viability (LHBT scaffold: 38.52% [17.94, 59.09] vs. native LHBT: 68.87% [63.67, 74.37]; P =.004). Tenocytes derived from the LHBT scaffold produced soluble signals that initiated ADMSC differentiation into an immature tenocyte-like phenotype, as indicated by an 8.7× increase in scleraxis (P = .040) and a 3.6× increase in collagen type III mRNA expression (P = .050) compared with undifferentiated ADMSC controls. CONCLUSIONS The ability to produce a viable autologous scaffold from the proximal biceps tendon having dimensions, porosity, mechanical characteristics, native ECM components, and viable tenocytes that produce bioactive signals conducive to supporting the biologic augmentation of rotator cuff repair surgery has been demonstrated. CLINICAL RELEVANCE This biologically active construct may help to improve the quality of healing and regeneration at the repair site of rotator cuff tears, especially those at high risk for retear.
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Affiliation(s)
- Gregory Colbath
- Medical Group of the Carolinas, Department of Orthopaedic Surgery, Spartanburg Regional, Spartanburg, SC
| | - Alison Murray
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Sandra Siatkowski
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Taylor Pate
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Mario Krussig
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Stephan Pill
- Steadman Hawkins Clinic of the Carolinas, Department of Orthopaedic Surgery, Prisma Health, Greenville, SC
| | - Richard Hawkins
- Steadman Hawkins Clinic of the Carolinas, Department of Orthopaedic Surgery, Prisma Health, Greenville, SC
| | - John Tokish
- Mayo Clinic, Department of Orthopaedic Surgery, Phoenix, AZ
| | - Jeremy Mercuri
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
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16
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Jensen C. Disorders of the Upper Extremity. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Brindisino F, Salomon M, Giagio S, Pastore C, Innocenti T. Rotator cuff repair vs. nonoperative treatment: a systematic review with meta-analysis. J Shoulder Elbow Surg 2021; 30:2648-2659. [PMID: 34020002 DOI: 10.1016/j.jse.2021.04.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff (RC) tears have been widely studied as many treatment strategies have been recommended. However, optimal management for patients with RC tears is still unclear. PURPOSE The main aim of this systematic review was to analyze randomized controlled trials using meta-analysis to compare repair to conservative treatments for patients with any type of RC tear. METHODS MEDLINE, Cochrane Library (CENTRAL database), PEDro, and Scopus databases were used. Two independent reviewers selected randomized controlled trials that compared surgical to conservative treatments for RC tear patients. The studies included were assessed using Cochrane Risk of Bias 2 tools, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the certainty of evidence and to summarize the study conclusions. RESULTS Six trials were included. Pooled results showed improvement in function and pain perception in favor of the repair group at 6 months (mean difference 1.26, 95% CI -2.34, 4.85, P = .49; and -0.59, 95% CI -0.84, -0.33, P < .001, respectively), at 12 months (mean difference 5.25, 95% CI 1.55, 8.95, P = .005, for function; and -0.41, 95% CI -0.70, -0.12, P = .006, for pain) and at 24 months (mean difference 5.57, 95% CI 1.86, 9.29, P = .003, for function; and -0.92, 95% CI -1.31, -0.52, P < .001, for pain) in RC tear patients. However, these differences did not reach the minimum clinically important difference. The certainty of evidence ranged from low to moderate because of imprecision in the studies included. CONCLUSIONS Overall analysis showed that in patients with RC tear, repair compared with conservative treatment could result in increased pain reduction and functional improvement at 6, 12, and 24 months. Even if these effects were often statistically significant, their clinical relevance was limited. Moreover, the certainty of body of evidence ranged from low to moderate.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio," University of Molise, Campobasso, Italy; Faculty of Medicine, University "Tor Vergata", Rome, Italy.
| | - Mattia Salomon
- Faculty of Medicine, University "Tor Vergata", Rome, Italy
| | - Silvia Giagio
- Department of Biomedical and Neuromotor Science (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Chiara Pastore
- Centro Sanitario Riabilitativo FisicaMente, Predazzo, Trentino, Italy
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, VU University, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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18
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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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19
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Anterior Cable Reconstruction of the Superior Capsule Using Semitendinosus Allograft for Large Rotator Cuff Defects Limits Superior Migration and Subacromial Contact Without Inhibiting Range of Motion: A Biomechanical Analysis. Arthroscopy 2021; 37:1400-1410. [PMID: 33359853 DOI: 10.1016/j.arthro.2020.12.183] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To biomechanically assess translation, contact pressures, and range of motion for anterior cable reconstruction (ACR) using hamstring allograft for large to massive rotator cuff tears. METHODS Eight cadaveric shoulders (mean age, 68 years) were tested with a custom testing system. Range of motion (ROM), superior translation of the humeral head, and subacromial contact pressure were measured at 0°, 30°, 60°, and 90° of external rotation (ER) with 0°, 20°, and 40° of glenohumeral abduction. Three conditions were tested: intact, stage III tear (supraspinatus + anterior half of infraspinatus), and stage III tear + allograft ACR (involving 2 supraglenoid anchors for semitendinosus tendon allograft fixation. Allograft ACR included loop-around fixation using 3 side-to-side sutures and an anchor at the articular margin to restore capsular anatomy along the anterior edge of the cuff defect. RESULTS ACR with allograft for stage III tears showed significantly higher total ROM compared with intact at all angles (P ≤ .028). Augmentation significantly decreased superior translation for stage III tears at 0°, 30°, and 60° ER for both 0° and 20° abduction, and at 0° and 30° ER for 40° abduction (P ≤ .043). Augmentation for stage III tears significantly reduced overall subacromial contact pressure at 30° ER with 0° and 40° abduction, and at 60° ER with 0° and 20° abduction (P ≤ .016). CONCLUSION Anterior cable reconstruction using cord-like allograft semitendinosus tendon can biomechanically improve superior migration and subacromial contact pressure (primarily in the lower combined abduction and rotation positions), without limiting range of motion for large rotator cuff tendon defects or tears. CLINICAL RELEVANCE In patients with superior glenohumeral instability, using hamstring allograft for ACR may improve rotator cuff tendon defect longevity by providing basic static ligamentous support to the dynamic tendon while helping to limit superior migration, without restricting glenohumeral kinematics.
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Zabrzyński J, Huri G, Gagat M, Łapaj Ł, Yataganbaba A, Szwedowski D, Askin M, Paczesny Ł. The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery. J Clin Med 2021; 10:599. [PMID: 33562734 PMCID: PMC7915659 DOI: 10.3390/jcm10040599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker's group and 84.06 and 30.93 in the non-smoker's group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers' group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.
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Affiliation(s)
- Jan Zabrzyński
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland;
- Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland;
- Department of Pathology, Faculty of Medicine, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland
| | - Gazi Huri
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06-532, Turkey; (G.H.); (A.Y.); (M.A.)
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland;
| | - Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland;
| | - Alper Yataganbaba
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06-532, Turkey; (G.H.); (A.Y.); (M.A.)
| | - Dawid Szwedowski
- Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, 20-133 Milan, Italy;
| | - Mehmet Askin
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06-532, Turkey; (G.H.); (A.Y.); (M.A.)
| | - Łukasz Paczesny
- Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland;
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DeFroda SF, Li L, Milner J, Bokshan SL, Owens BD. Cost comparison of arthroscopic rotator cuff repair with arthroscopic vs. open biceps tenodesis. J Shoulder Elbow Surg 2021; 30:340-345. [PMID: 32562763 DOI: 10.1016/j.jse.2020.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE To use a nationwide database to determine differences in cost between patients who underwent arthroscopic rotator cuff tear with open vs. arthroscopic biceps tenodesis (BT). METHODS The 2014 State Ambulatory Surgical and Services Databases from 6 US states was utilized. All cases with CPT codes 29827 (arthroscopic rotator cuff repair [RCR]) and either 23430 (tenodesis of long tendon of biceps) or 29828 (arthroscopic BT) were selected. Cases that included both 23430 and 29828 were excluded, as were those missing demographic data. Generalized linear models were used to model costs based on the surgical and patient variables that were significant in the initial bivariate analysis (P < .05). RESULTS A total of 3635 RCR and BT cases were identified. There were 2847 (78.3%) with arthroscopic BT and 788 (21.7%) with open BT. Patients undergoing arthroscopic BT were 3.1 years older than patients undergoing open BT (P < .001). For arthroscopic BT, 39.2% of the cases were women compared with 22.6% of the open cases (P < .001). For operative variables, arthroscopic BT required 9 fewer minutes in the OR than open cases (P = .002). Concomitant distal clavicle resection was performed in 35.5% of arthroscopic BT cases compared with 29.8% of open cases (P = .004). While controlling for other significant factors, open BT was associated with $5542 lower costs than arthroscopic BT in the setting of RCR (P < .001). In either case, concomitant subacromial decompression added $10,669 (P < .001), and distal clavicle resection added $3210 (P < .001). High-volume surgical facilities were associated with $4107 lower costs (P < .001). CONCLUSIONS In a large series of patients undergoing arthroscopic RCR with open vs. arthroscopic BT, open BT was associated with $5542 lower costs than arthroscopic. Given that both techniques have been shown to be similarly effective in long-term follow-up, surgeons should be aware of opportunities for cost saving, particularly with the advent of bundled surgical reimbursements.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA.
| | - Lambert Li
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - John Milner
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - Steven L Bokshan
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
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Kaar SG. CORR Insights®: Compensatory Movement Patterns Are Based on Abnormal Activity of the Biceps Brachii and Posterior Deltoid Muscles in Patients with Symptomatic Rotator Cuff Tears. Clin Orthop Relat Res 2021; 479:389-391. [PMID: 33475299 PMCID: PMC7899594 DOI: 10.1097/corr.0000000000001580] [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: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Scott G Kaar
- S. G. Kaar, Department of Orthopedic Surgery, Saint Louis University, St. Louis, MO, USA
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Zabrzynski J, Gagat M, Paczesny L, Grzanka D, Huri G. Correlation between smoking and neovascularization in biceps tendinopathy: a functional preoperative and immunohistochemical study. Ther Adv Chronic Dis 2020; 11:2040622320956418. [PMID: 33101619 PMCID: PMC7549321 DOI: 10.1177/2040622320956418] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
Aims The purpose of this study was to investigate whether smoking is associated with neovascularization in the tendinopathy of the long head of the biceps tendon (LHBT). Methods The study included 40 consecutive patients who underwent arthroscopic biceps tenotomy/tenodesis due to chronic biceps tendinopathy and divided into three groups: (1) non-smokers, (2) former smokers, (3) smokers. LHBT tissue samples were stained with H&E, Alcian blue and Trichrome staining. Immunohistochemical examination was performed using anti-CD31 and anti-CD34. The neovessel density score (NDS) was scored by Bonar criteria. Results The mean period of smoking was 15.50 years with an average number of 24 cigarettes/day in the former smokers and 21.69 years with an average number of 15 cigarettes/day in the active smokers. The mean NDS was 2.23/3 in non-smokers, whereas it was 1.60/3 in former smokers and 1.31/3 in active smokers. The mean American Shoulder and Elbow Surgeons score equaled 46 in never smoked patients, 43.60 in former smokers, and 41.46 in active smokers. In the patients with smoking history, the disorganized tendinous tissue islands were avascular and composed of compact acidic polysaccharides and mucopolysaccharides. We observed negative correlation between the NDS and the smoking indexes, including cigarettes per day (p = 0.0150), smoking years (p = 0.0140), pack-years (p = 0.0088). Conclusion In conclusion, the present study revealed that smoking impairs the vascularization of the biceps tendon in chronic tendinopathy. Clinically, we observed a negative correlation between smoking and neovascularization. Furthermore, there was no correlation between neovascularization and functional preoperative status.
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Affiliation(s)
- Jan Zabrzynski
- Department of Orthopedics, Orvit Clinic, Citomed Healthcare Center, Torun, Poland
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Torun, Poland
| | - Lukasz Paczesny
- Department of Orthopedics, Orvit Clinic, Citomed Healthcare Center, Torun, Poland
| | - Dariusz Grzanka
- Department of Pathology, Faculty of Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Torun, Poland
| | - Gazi Huri
- Orthopedics and Traumatology Department, Hacettepe Universitesi, Ankara, Turkey
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Rosenthal J, Nguyen ML, Karas S, Gottschalk M, Daly C, Wagner E, Singer AD. A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the proximal biceps brachii. Skeletal Radiol 2020; 49:1333-1344. [PMID: 32219466 DOI: 10.1007/s00256-020-03415-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/26/2020] [Accepted: 03/08/2020] [Indexed: 02/02/2023]
Abstract
The biceps brachii myotendinous unit, particularly the long head of the biceps tendon and its labral attachment, is a common cause of shoulder and arm pain. Its complex anatomy and normal variations can present a challenge when interpreting MR images. The purpose of this manuscript is to review the proximal biceps anatomy, variants, pathology, and post-operative appearance as seen on MRI. Recent data regarding the accuracy of clinical examination and MRI will be summarized.
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Affiliation(s)
| | - My-Linh Nguyen
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Spero Karas
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | | | - Charles Daly
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Eric Wagner
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
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Ayzenberg M, Hiller AD, Vellinga R, Snyder SJ. Arthroscopic supraglenoid origin-preserving biceps tenodesis: a reliable, simple, and cost-conscious technique. J Shoulder Elbow Surg 2020; 29:S73-S79. [PMID: 32643611 DOI: 10.1016/j.jse.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the midterm clinical and ultrasonographic outcomes of a new all arthroscopic supraglenoid origin-preserving tenodesis technique of the long head of the biceps (LHB) brachii tendon in the setting of small to medium-sized rotator cuff repairs. MATERIALS AND METHODS Thirty patients (33 shoulders) meeting inclusion criteria were identified who underwent LHB tenodesis with this technique in the setting of small to medium-sized rotator cuff repair at a mean age at surgery of 65.6 years between 2015 and 2017. Rotator cuff tears were repaired using the Southern California Orthopedic Institute (SCOI) row technique. The biceps tenodesis was incorporated into the anterior anchor of the rotator cuff repair after bony groove preparation, including débridement and bone vent placement. Frayed edges of the biceps tendon were gently débrided, but the intra-articular glenoid attachment was left intact. Patients were assessed at follow-up by clinical and ultrasonographic examination, as well as a satisfaction questionnaire, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score and visual analog scale (VAS) score. RESULTS Mean follow-up was 32.9 months for the 27 patients (30 shoulders), resulting in a 91% follow-up. Average ASES score was 94.4. Average patient-reported satisfaction with shoulder function was 9.4 of 10 and with biceps contour was 9.9 of 10. Average VAS score was 0.6 of 10, and 73% of patients reported a VAS score of 0. Ultrasonography demonstrated an intact biceps tendon in 27 of 28 shoulders and an intact supraspinatus tendon in all 28 shoulders. Mean range of motion was 170° in forward flexion, 169° in abduction, 49° in external rotation, and to thoracic vertebrae 12 in internal rotation. Mean muscle grading during Jobe test was 4.8 of 5. There were no intraoperative complications. No patients required revision surgery. CONCLUSIONS In situ arthroscopic biceps tenodesis with maintenance of the glenoid attachment incorporated into rotator cuff repair yields a high rate of healing and consistently excellent functional and cosmetic outcomes as well as patient satisfaction while saving surgical time and cost.
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Affiliation(s)
- Mark Ayzenberg
- Southern California Orthopedic Institute, Van Nuys, CA, USA.
| | | | - Ryan Vellinga
- Southern California Orthopedic Institute, Van Nuys, CA, USA
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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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Jensen C. Disorders of the Upper Extremity. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Juhan T, Stone M, Jalali O, Curtis W, Prodromo J, Weber AE, Hatch GF, Omid R. Irreparable rotator cuff tears: Current treatment options. Orthop Rev (Pavia) 2019; 11:8146. [PMID: 31616552 PMCID: PMC6784596 DOI: 10.4081/or.2019.8146] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/07/2019] [Indexed: 01/07/2023] Open
Abstract
Rotator cuff disease is one of the most common causes of shoulder pain, yet controversy still exists regarding treatment of "irreparable" tears. Nonoperative management, including physical therapy and steroid injections, should be reserved for those without significant pain or functional impairment. Debridement may be used for low-demand patients, and should be performed with partial cuff repair, subacromial decompression, and/or acromioplasty to maximize outcomes. Biceps tenotomy and/or tenodesis have been shown to reduce postoperative pain and improve satisfaction when performed in conjunction with rotator cuff repairs, with no difference in functional outcome comparatively. Tendon transfers have been advocated with the potential benefit to improve function and decrease pain. More recently, extracellular matrix and human-derived dermal allografts have been used off-label as patch grafts in irreparable tears. Superior capsular reconstructive techniques and subacromial balloon spacers serve a similar function by acting to depress the humeral head in a cuff-deficient shoulder, however long-term data is needed before widespread adoption of these procedures. Finally, reverse shoulder arthroplasty serves as a salvage option for low demand elderly patients.
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Affiliation(s)
- Tristan Juhan
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michael Stone
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Omid Jalali
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Will Curtis
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - John Prodromo
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Alexander E Weber
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - George Frederick Hatch
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Reza Omid
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
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Cua RCA, Hsiao MY. A Female Laborer with Right Anterior Shoulder Pain. J Med Ultrasound 2019; 26:229-230. [PMID: 30662160 PMCID: PMC6314100 DOI: 10.4103/jmu.jmu_37_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ronald Christopher A Cua
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, 1008 Metro Manila, Philippines, Taiwan
| | - Ming Yen Hsiao
- Departments of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Pouliquen L, Berhouet J, Istvan M, Thomazeau H, Ropars M, Collin P. Popeye sign: Frequency and functional impact. Orthop Traumatol Surg Res 2018; 104:817-822. [PMID: 29803774 DOI: 10.1016/j.otsr.2018.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 02/13/2018] [Accepted: 02/27/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is currently no consensus on the choice between tenotomy and tenodesis of the long head of the biceps tendon in rotator cuff repair. The Popeye sign is often seen as a drawback of tenotomy. The main objective of the present study was to determine the frequency and clinical impact of the Popeye sign. HYPOTHESIS The Popeye sign is rarely found clinically, and shows little functional impact following tenotomy. MATERIALS AND METHODS A single-center non-randomized prospective study was conducted between February and October 2015 in all patients undergoing rotator cuff surgery. Patients without surgery on the long head of the biceps tendon were excluded. The rate of Popeye sign was assessed 6 months postoperatively. Tenotomy patients with and without Popeye sign were compared in terms of pain on visual analog scale≤3, gain in range of motion, improvement in subjective shoulder value, discomfort or cramps and gain in Constant score. RESULTS Seven of the 55 patients included (15.2%) showed postoperative Popeye sign. There were no differences between the groups with and without Popeye sign on any of the assessment criteria except for a significantly greater improvement in mean Constant range of motion score in the Popeye group: gain of 13.8 versus 3.8 points; p=0.01. DISCUSSION The Popeye sign was relatively rarely observed. Functional impact in the present study was slight. Longhead of the biceps tenotomy is a justifiable treatment option in case of associated rotator cuff tear repair. LEVEL OF EVIDENCE IV, prospective non-randomized.
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Affiliation(s)
- Laure Pouliquen
- Service d'orthopédie, traumatologie, CHRU Pontchaillou, 35000 Rennes, France
| | - Julien Berhouet
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François Rabelais de Tours, CHRU Trousseau, 37170 Chambray-les-Tours, France
| | - Marion Istvan
- Service de Santé publique, CHRU Pontchaillou, 35000 Rennes, France
| | - Hervé Thomazeau
- Service d'orthopédie, traumatologie, CHRU Pontchaillou, 35000 Rennes, France
| | - Mickael Ropars
- Service d'orthopédie, traumatologie, CHRU Pontchaillou, 35000 Rennes, France
| | - Philippe Collin
- Service d'orthopédie, Clinique Saint-Grégoire, 35000 Rennes, France.
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Bottegoni C, Farinelli L, Aquili A, Manzotti S, Baldini M, Gigante A. Fibrocartilaginous metaplasia identified in the long head of the biceps brachii. J Shoulder Elbow Surg 2018; 27:1221-1225. [PMID: 29567036 DOI: 10.1016/j.jse.2018.02.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/28/2018] [Accepted: 02/01/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the glenohumeral joint, the long head of biceps brachii (LHBB) is exposed to tension and compression loading. The short head of biceps brachii (SHBB) works only in tension. It is known that tendon under compression might develop fibrocartilaginous metaplasia that improves the resistance to compression but reduces the resistance to tension. This study evaluated the presence of cartilage in LHBB and SHBB samples, supporting its possible role in tendon tear. METHODS Between 2014 and 2016, 13 samples of LHBB and SHBB were collected during surgery for shoulder instability, glenohumeral arthritis, and massive rotator cuff tears. The samples were stained with hematoxylin and eosin, safranin-O, and Alcian blue (pH 1.0) for light microscopy. Immunohistochemistry was performed using anti-S100, anti-collagen I and II, and anti-tenascin-C antibodies. RESULTS Histochemistry: LHBB samples showed matrix disorganization, with clusters of chondrocyte surrounded by collagen fibers and glycosaminoglycans. Safranin-O showed evident metachromasia. SHBB samples did not show any matrix disorganization or cartilaginous metaplasia. Immunohistochemistry: In all LHBB samples, anti-S100 and anti-collagen II showed cartilage in proximity of the tendon tear. Tenascin C immunostained closely to the disorganized matrix areas. SHBB, however, showed no positive areas for S-100, anti-collagen II, or tenascin C. CONCLUSIONS According to our results, we hypothesize that the repeated stimulation in compression may induce the formation of fibrous cartilage. However, to date its role in tendon pathology remains to be clearly defined.
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Affiliation(s)
- Carlo Bottegoni
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Alberto Aquili
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Sandra Manzotti
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Marco Baldini
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Ancona, Italy.
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Kowalczuk M, Kohut K, Sabzevari S, Naendrup JH, Lin A. Proximal Long Head Biceps Rupture: A Predictor of Rotator Cuff Pathology. Arthroscopy 2018; 34:1166-1170. [PMID: 29373291 DOI: 10.1016/j.arthro.2017.10.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether acute rupture of the proximal long head biceps is a harbinger of disease of the nearby supraspinatus and subscapularis tendons. METHODS A retrospective chart review from February 1, 2008, to August 31, 2016, was performed at our institution identifying patients who presented with an acute (<12-week) history of "Popeye" deformity of the distal biceps and a magnetic resonance imaging (MRI) of the affected shoulder. MRI images were then reviewed in duplicate to determine supraspinatus and subscapularis tendon tear incidence, size, chronicity, and depth. The association between rotator cuff status and acute long head biceps rupture as well as patient age, sex, smoking status, hand dominance, and history of diabetes mellitus or trauma was then evaluated. RESULTS A total of 116 patients were included in this study (mean age: 61.9 ± 10.9 years). A significant proportion (n = 99; incidence: 85%) were found to have some degree of supraspinatus or subscapularis tendon tearing on MRI (P < .001). These patients were also found to be significantly older compared with those with an intact rotator cuff (mean age 63.3 ± 10.7 vs 54.2 ± 9.2; P = .001). Full thickness rotator cuff tears were significantly more likely to involve the supraspinatus as opposed to the subscapularis (incidence: 44% and 21%; P = .002). CONCLUSIONS Despite the expected association of rotator cuff disease with increasing patient age, the results of this study also affirm the hypothesis that inflammation in the rotator cuff interval signaled by rupture of the long head of biceps is a harbinger of rotator cuff disease. Clinicians should have a high index of suspicion regarding concomitant anterosuperior rotator cuff pathology in patients presenting with acute long head of biceps rupture. Early evaluation with advanced imaging should be strongly considered. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Marcin Kowalczuk
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Kevin Kohut
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Soheil Sabzevari
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A..
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Effect of patient age on accuracy of primary MRI signs of long head of biceps tearing and instability in the shoulder: an MRI-arthroscopy correlation study. Skeletal Radiol 2018; 47:203-214. [PMID: 28983764 DOI: 10.1007/s00256-017-2783-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/15/2017] [Accepted: 09/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of patient age on the accuracy of primary MRI signs of long head of biceps (LHB) tendon tearing and instability in the shoulder using arthroscopy as a reference standard. MATERIALS AND METHODS Subjects with MRI studies and subsequent arthroscopy documenting LHB tendon pathology were identified and organized into three age groups (18-40, 41-60, 61-87). Normal and tendinopathic tendons were labeled grade 0, partial tears grade 1 and full tears grade 2. Two radiologists blinded to arthroscopic data graded MRI studies independently. Prevalence of disease, MRI accuracy for outcomes of interest, and inter-reader agreement were calculated. RESULTS Eighty-nine subjects fulfilled inclusion criteria with 36 grade 0, 36 grade 1 and 17 grade 2 tendons found at arthroscopy. MRI sensitivity, regardless of age, ranged between 67-86% for grade 0, 72-94% for grade 1 and 82-94% for grade 2 tendons. Specificity ranged between 83-96% for grade 0, 75-85% for grade 1 and 99-100% for grade 2 tendons. MRI accuracy for detection of each LHB category was calculated for each age group. MRI was found to be least sensitive for grade 0 and 1 LHB tendons in the middle-aged group with sensitivity between 55-85% for grade 0 and 53-88% for grade 1 tendons. Agreement between MRI readers was moderate with an unweighted kappa statistic of 62%. CONCLUSION MRI accuracy was moderate to excellent and agreement between MRI readers was moderate. MRI appears to be less accurate in characterizing lower grades of LHB tendon disease in middle-aged subjects.
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Smith CR, Yoon JT, Long JR, Friedman MV, Hillen TJ, Stensby JD. The Radiologist’s Primer to Imaging the Noncuff, Nonlabral Postoperative Shoulder. Radiographics 2018; 38:149-168. [DOI: 10.1148/rg.2018170061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Christopher R. Smith
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jason T. Yoon
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jeremiah R. Long
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Michael V. Friedman
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Travis J. Hillen
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - James D. Stensby
- From the Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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Ohzono H, Gotoh M, Nakamura H, Honda H, Mitsui Y, Kakuma T, Okawa T, Shiba N. Effect of Preoperative Fatty Degeneration of the Rotator Cuff Muscles on the Clinical Outcome of Patients With Intact Tendons After Arthroscopic Rotator Cuff Repair of Large/Massive Cuff Tears. Am J Sports Med 2017; 45:2975-2981. [PMID: 28906128 DOI: 10.1177/0363546517724432] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fatty degeneration of the rotator cuff muscles is associated not only with postoperative retear but also with postoperative muscle weakness; therefore, fatty changes in the muscles may affect the clinical outcome even in patients with these tears who have intact tendons after arthroscopic rotator cuff repair (ARCR). PURPOSE To evaluate the effect of fatty infiltration on the clinical outcome in patients with intact tendons after arthroscopic repair of large/massive cuff tears. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS One hundred fifty-five consecutive patients with large/massive rotator cuff tears underwent ARCR. Of these, 55 patients (mean ± SD age, 64.4 ± 9.1 years) in whom intact tendons after surgery were confirmed with magnetic resonance imaging at final follow-up (mean ± SD, 2.5 ± 1.4 years) were included in this study. Depending on their University of California Los Angeles (UCLA) score at the final follow-up, they were assigned to either the unsatisfactory group (score ≤27; n = 12) or the satisfactory group (score >27; n = 43). Various clinical parameters affecting the clinical outcome were examined through univariate and multivariate analyses. RESULTS The UCLA score of all patients significantly improved from 18.1 ± 4.4 points preoperatively to 29.8 ± 4.5 points postoperatively ( P < .0001). The mean preoperative UCLA scores were not significantly different between the satisfactory and unsatisfactory groups ( P = .39). Multivariate analysis showed that the preoperative Goutallier stages of the infraspinatus (odds ratio [OR], 8.87; 95% confidence interval [CI], 1.51-52.0; P = .016) and/or subscapularis (OR, 7.53; 95% CI, 1.58-35.9; P = .011) were significantly associated with outcome. Receiver operating characteristic curve analysis revealed a cutoff value of Goutallier stage 1 in both muscles, with area under the curve values of 0.79 (sensitivity 91% and specificity 51%) and 0.84 (sensitivity 100% and specificity 54%) in the infraspinatus and subscapularis, respectively. CONCLUSION Preoperative fatty degeneration of the infraspinatus and/or subscapularis with Goutallier stage 2 or higher was significantly associated with worse outcome in patients with large/massive tears who had intact tendons after ARCR.
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Affiliation(s)
- Hiroki Ohzono
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopaedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Hidehiro Nakamura
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirokazu Honda
- Department of Orthopaedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Yasuhiro Mitsui
- Department of Orthopaedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatistics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takahiro Okawa
- Department of Orthopaedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Maffulli N, Papalia R, Torre G, Vasta S, Papalia G, Denaro V. No difference between tenotomy vs tenodesis for the long head of the biceps tendinopathy in rotator cuff repair: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Progression of degenerative changes of the biceps tendon after successful rotator cuff repair. J Shoulder Elbow Surg 2017; 26:424-429. [PMID: 27914841 DOI: 10.1016/j.jse.2016.09.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study investigated the morphologic changes in the biceps tendon using ultrasonography before and after successful arthroscopic posterosuperior rotator cuff repair. METHODS Forty-four patients (44 shoulders) underwent arthroscopic posterosuperior rotator cuff repair with 1-year postoperative magnetic resonance imaging (MRI) follow-up. The patients comprised 22 men and 22 women with an average age of 61 years. The cross-sectional area (CSA) of the biceps tendon in the bicipital groove was measured, and the vascularity in the bicipital groove was graded as 0 to 3, based on the signal density of the anterior circumflex artery, using power Doppler ultrasonography. The preoperative and postoperative CSA and vascularity grades were compared. The pain score on the University of California, Los Angeles Shoulder Rating Scale was used to analyze the correlation between vascularity and postoperative pain. RESULTS The average preoperative and postoperative CSA of the biceps tendon was 15.4 ± 6.5 and 17.9 ± 7.5 mm2, respectively. The postoperative CSA was significantly larger than the preoperative CSA (P < .01). Although no significant difference in the vascularity of the bicipital groove was observed between preoperative and postoperative grading, a negative correlation was observed between the vascularity and postoperative pain score on the University of California, Los Angeles scale (r = -0.369). CONCLUSIONS The biceps tendon in the bicipital groove becomes thicker over time, even after successful posterosuperior rotator cuff repair. In addition, an increase in the vascularity around the biceps tendon in the groove is correlated with pain symptoms after successful repair.
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Electromyographic Activities of the Rotator Cuff Muscles During Walking, Eating, and Washing. Am J Phys Med Rehabil 2016; 95:e169-e176. [PMID: 27763907 DOI: 10.1097/phm.0000000000000587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the activity of rotator cuff (RC) muscles during activities of daily living. DESIGN Motion analysis was conducted with 14 volunteers. Activation of RC (subscapularis, supraspinatus, and infraspinatus) was assessed using electromyography (EMG). Walking was performed with or without a shoulder immobilizer. Eating was conducted with or without the support of the elbow with the contralateral hand. Washing the hair was simulated while standing or leaning forward; washing the body was simulated while standing or holding the elbow; and washing the face was simulated using both hands while leaning forward. RESULTS During walking, RC's peak EMG activities remained below 7% maximum voluntary isometric contraction at all times, regardless of the use of immobilizers. Eating caused mild EMG activities (14%-32%), whereas eating with elbow support resulted in significantly lower EMG activities in the supraspinatus and infraspinatus. Washing the hair standing moderately activated RC (23%-57%), whereas leaning forward decreased it to 6% to 36%. Washing the body while holding the elbow decreased infraspinatus activation to 4% from 10% when standing. Washing the face with both hands and leaning forward resulted in high-peak EMG activities in the upper subscapularis (37%). CONCLUSIONS There was no difference in RC activity level between walking with or without immobilizers. From the point of muscle contraction, an immobilizer is not mandatory. Holding the elbow with the contralateral hand while eating or washing can help decrease the load in the supraspinatus and infraspinatus.
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