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Park HS, Ham KH, Kim YS. The Arthroscopic Biceps Rerouting Technique Shows Better Early Clinical Outcomes within 1 Year Than Partial Repair in Large to Massive Rotator Cuff Tears. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:240. [PMID: 38399528 PMCID: PMC10890027 DOI: 10.3390/medicina60020240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The arthroscopic biceps rerouting (BR) technique was introduced as a novel technique for large-to-massive rotator cuff tears (LMRCTs). This method can restore shoulder stability, and its biomechanical effect was verified in a cadaver experiment. Recent reports have shown favorable clinical outcomes. This study aimed to compare the clinical outcomes of partial repair with those of the BR technique in LMRCTs. Materials and Methods: We included 72 patients who had undergone LMRCTs. Arthroscopic partial repair was performed in 31 patients (group I), while repair with the BR technique was performed in 41 patients (group II). Functional and imaging outcomes were evaluated and compared using a visual analog scale for pain, range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Korean Shoulder Score (KSS) before the surgery and at 3, 6, and 12 months after the surgery and at the last follow-up. Tendon integrity was investigated using magnetic resonance in all the patients at 12 months postoperative. Results: The mean follow-up period was 22.11 ± 10.47 months (range, 12-53 months). Forward flexion (p = 0.02) and external rotation at the side (p = 0.04) were significantly higher in group II than in group I on postoperative day (POD) 12 months. For internal rotation, group II showed significant improvement compared to group I on POD 3 months (p = 0.002) and at 6 months postoperative (p = 0.01). On POD 12 months, the ASES (p = 0.047) and KSS (p = 0.048) were better in group II. Significant improvements in pain and clinical scores were observed in both groups at the last follow-up. However, the two groups had no significant differences in pain, clinical scores, or ROM at the last follow-up. Retear of the repaired tendon was observed in nine patients in group I (29.03%) and eight in group II (19.51%, p = 0.35). Conclusions: Partial repair and repair using the BR technique effectively improved clinical and radiologic outcomes. The BR technique revealed early recovery of ROM and better clinical results than partial repair at one year postoperative. This could be a useful method in treating LMRCTs.
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Affiliation(s)
- Hyung-Seok Park
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea; (H.-S.P.); (K.-H.H.)
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
| | - Kwon-Hyoung Ham
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea; (H.-S.P.); (K.-H.H.)
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 14662, Republic of Korea
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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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Aicale R, Poeta N, Savarese E, Bernardini G, Oliva F, Maffulli N. The use of long head biceps tendon autograft for massive rotator cuff tears: a PRISMA compliant systematic review. Br Med Bull 2022; 144:76-89. [PMID: 36244058 DOI: 10.1093/bmb/ldac021] [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] [Accepted: 08/30/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Rotator cuff tears (RCT) are a common cause of shoulder pain and disability, with massive RCT accounting for 10-40% of all rotator cuff tears. SOURCES OF DATA A systematic search of PubMed and Scopus electronic databases was performed up to August 2022, and a total of 17 scientific articles were included in the present PRISMA compliant systematic review. AREAS OF AGREEMENT Understanding the geometric patterns in RCT is essential to achieve appropriate repositioning of the injured tendons in their anatomic location. The long head of the biceps tendon (LHBT) is usually exposed when defects of the anterolateral corner are present and can be easily used to augment rotator cuff repairs. AREAS OF CONTROVERSY There are no definite guideline regarding the management of massive rotator cuff tears. GROWING POINTS The use of LHBT graft is safe and effective, but technically demanding. All studies were level IV articles of medium to high quality. AREAS TIMELY FOR DEVELOPING RESEARCH Prospective long term follow-up studies and randomized controlled trials are needed, adding imaging evaluation and appropriate clinical outcome measures at follow-up.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'AragonaSalerno 84131, Italy
| | - Nicola Poeta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona Salerno 84131, Italy
| | - Eugenio Savarese
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto 74121, Italy
| | - Giulio Bernardini
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto 74121, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona Salerno 84131, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona Salerno 84131, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London E1 4DG, England
- Keele University, School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England
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Llinás PJ, Bailie DS, Sanchez DA, Chica J, Londono JF, Herrera GA. Partial Superior Capsular Reconstruction to Augment Arthroscopic Repair of Massive Rotator Cuff Tears Using Autogenous Biceps Tendon: Effect on Retear Rate. Am J Sports Med 2022; 50:3064-3072. [PMID: 35983981 DOI: 10.1177/03635465221112659] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Massive rotator cuff tears have a high incidence of postoperative retear that can reach 90%. It is still unclear which intervention may reduce the incidence of retear and improve the functional and clinical outcomes. PURPOSE/HYPOTHESIS The purpose of this study was to investigate the clinical and structural outcomes at 2 years after repair of reparable massive rotator cuff tears with and without the use of partial superior capsular reconstruction (pSCR), using the autologous long head of the biceps tendon (LHBT) as a graft. It was hypothesized that augmentation with a pSCR would decrease retear rates. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors compared arthroscopic repair of massive posterosuperior rotator cuff tears with and without augmentation using the LHBT for pSCR between 2015 and 2017. After applying the selection criteria, 106 patients were included in the study and distributed into 2 groups of 50 and 56 patients. Patients in the first group (50 patients) underwent arthroscopic repair without use of the LHBT (AR group), and patients in the second group (56 patients) underwent arthroscopic repair with use of the LHBT for pSCR (AR-LHBT group). The structural outcome was evaluated by ultrasound at 2 years of follow-up. Function and pain were evaluated preoperatively and at the 2-year follow-up using the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS). Pre- and postoperative active range of motion, including forward elevation, external rotation, and abduction, were also documented. RESULTS No significant differences were found between groups regarding the baseline characteristics. After 24 months, both groups showed significant improvement from preoperative ASES scores, VAS score, and active range of motion (P < .01 for all). Patients in the AR-LHBT group showed significant improvements in postoperative functional and pain scores compared with the AR group in all measurements at the 2-year follow-up (ASES score: 77.23 ± 7.45 vs 71.04 ± 9.28, P < .01; VAS score: 1.64 ± 1.03 vs 2.12 ± 1.06, P < .01). Final range of motion was significantly increased for the AR-LHBT group for forward elevation (155 [interquartile range {IQR}, 150-160] vs 150 [IQR, 140-170]; P < .01) and abduction (150 [IQR, 140-157.5] vs 120 [IQR, 100-140]; P < .01), but external rotation was significantly greater for the AR group (54.43 ± 10.55 vs 59.5 ± 10.55; P < .01). Postoperative ultrasonography at the 2-year follow-up revealed a higher retear rate in the AR group than in the AR-LHBT group (46% vs 14%; P < .01). CONCLUSION Use of the LHBT for pSCR to augment massive rotator cuff tears resulted in markedly lower retear rates and modestly improved pain and function outcomes compared with repair alone.
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Affiliation(s)
- Paulo J Llinás
- Fundación Valle del Lili, Cali, Colombia.,Universidad ICESI Facultad de Medicina, Cali, Colombia
| | - David S Bailie
- Arizona Institute for Sports, Knees, and Shoulders, LLC, Scottsdale, Arizona, USA
| | | | - Julian Chica
- Fundación Valle del Lili, Clinical Research Center, Cali, Colombia
| | - Juan Francisco Londono
- Fundación Valle del Lili, Cali, Colombia.,Fundación Valle del Lili, Clinical Research Center, Cali, Colombia
| | - Gilberto A Herrera
- Fundación Valle del Lili, Cali, Colombia.,Universidad ICESI Facultad de Medicina, Cali, Colombia
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Luciani P, Farinelli L, De Berardinis L, Gigante A. The Arthroscopic Intra-Articular Stabilization of the Shoulder for Irreparable Rotator Cuff Tear: A New Technique Proposal. Front Surg 2021; 8:624100. [PMID: 34938765 PMCID: PMC8685248 DOI: 10.3389/fsurg.2021.624100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure. Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM). Study Design: To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system. Methods: STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario. Results: With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM. Conclusion: Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.
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Affiliation(s)
- Pierfrancesco Luciani
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Luca De Berardinis
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
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Clavert P, Bruyere A, Ollivier I, Nourrissat G, Lädermann A. An anatomical study of the fetal superior capsule of the glenohumeral joint. Orthop Traumatol Surg Res 2021; 107:103073. [PMID: 34562650 DOI: 10.1016/j.otsr.2021.103073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The superior part of the glenohumeral joint capsule has an intimate relationship with the tendons of the rotator cuff and the tendon of the long head of the biceps. One of the strategies currently proposed in the event of a massive cuff rupture is to reconstruct this superior capsule. The main objective of this anatomical study was to describe the superior joint capsule of the embryonic glenohumeral joint and its relationship to the tendons of the rotator cuff. HYPOTHESIS The hypothesis was that this structure was an anatomical entity, morphologically identifiable from the embryogenesis of the joint (more pronounced tissue boundaries in the fetus). MATERIAL AND METHODS In total, 101 continuous fetal anatomical sections (4 fetuses of 336mm), in the frontal plane, made it possible to identify and measure: diameters of the humeral head and glenoid, dimensions of the joint capsule insertion zone at the level of the greater tubercle, as well as the different thicknesses of this insertion zone. The ratios above the head of the biceps and against the superior labrum were also measured. RESULTS At the level of its distal insertion on the greater tuberosity, the thickness of the superior joint capsule varies on average between 0.8mm laterally and 1.2mm next to the tendons of the supraspinatus and infraspinatus; the thickness is 0.9mm next to the middle part of the supraspinatus tendon (the "rotator cable" zone). For its insertion at the level of the glenoid labrum, the superior capsule measures 0.6mm thick on average. The capsule around the tendon of the long head of the biceps is 1.5mm thick on average. DISCUSSION Here, we confirm the existence of this superior joint capsule, which can potentially be reconstructed. It is inserted on the greater tubercle covering 30 to 60% of its surface with variations in thickness. The joint capsule is fused to the supraspinatus tendon at the rotator cuff insertion area, preventing independent reinsertion of the tendon. LEVEL OF EVIDENCE IV; anatomical study.
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Affiliation(s)
- Philippe Clavert
- Faculté de médecine, institut d'anatomie, 4, rue Kirschleger, 67085 Strasbourg cedex, France.
| | - Alexandra Bruyere
- Faculté de médecine, institut d'anatomie, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - Irène Ollivier
- Faculté de médecine, institut d'anatomie, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | | | - Alexandre Lädermann
- Service d'orthopédie et traumatologie, hôpital de la Tour, avenue J.-D.-Maillard 3, 1217 Meyrin, Switzerland; Faculté de médecine medicine, université de Genève, rue Michel-Servet 1, 1206 Geneva, Switzerland; Service d'orthopédie et traumatologie, Department de Chirurgie, rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Farazdaghi A, Paschos NK, Kelly JD. Comparison between partial and full coverage repair in massive rotator cuff tears. A minimum five year follow-up. Orthop Traumatol Surg Res 2021; 107:102911. [PMID: 33798791 DOI: 10.1016/j.otsr.2021.102911] [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: 04/13/2020] [Revised: 11/08/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Massive rotator cuff surgical management can be challenging. Controversy exists in the literature regarding the potential benefit of full head coverage for arthroscopic rotator cuff repair. The purpose of this study was to compare re-tear rate and clinical outcome of arthroscopic repair of massive rotator cuff tears in relation to the achievement of full humeral head footprint coverage or not. Hypothesis We hypothesized that there will be no difference in re-tear rate and clinical outcomes between full and partial coverage rotator cuff repairs. PATIENTS AND METHODS A retrospective analysis of all adult patients with a massive rotator cuff tear who underwent arthroscopic repair with a minimum five years follow-up was performed. Outcomes analyzed included re-tear rate, the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, and the Penn Shoulder Score. Correlation and subgroup analyses were performed in order to evaluate whether age, symptom duration, tear size, coverage percentage, and fatty infiltration had any effect in outcome. RESULTS The average ASES score was 76.3±25.2, and average Penn Shoulder Score was 75.8±23.1 at 7.9 years mean follow-up in 27 patients analyzed. Re-tear rate was similar between full and partial footprint coverage repair with 2 versus 4 failures, respectively (p=0.64). ASES and Penn Shoulder scores were 84.2 and 83.7 for full rotator cuff repair versus 70.6 and 71.1, for partial coverage repair (p=0.20 and p=0.22, respectively). The percentage of head coverage and the tear size were both found to be significantly correlated with outcome, with coefficient of determination R2 of 0.40 and 0.217, respectively, while a global fatty degeneration index GFDI <1.5 was associated with improved functional outcome. DISCUSSION No difference in failure rate and functional outcome was detected between full and partial coverage rotator cuff repair. The size of the tear and fatty infiltration were inversely correlated with functional score while the percentage of coverage achieved was positively correlated with favorable outcome. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Armin Farazdaghi
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Nikolaos K Paschos
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, U.S.A; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A.
| | - John D Kelly
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, U.S.A
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Zhang H, Jiang C. The Elongation of Biceps Muscle Tendon Unit After Rerouting of the Long Head of Biceps Tendon as Superior Capsular Augmentation: A Quantitative Measurement. Arthrosc Sports Med Rehabil 2020; 2:e531-e537. [PMID: 33134991 PMCID: PMC7588644 DOI: 10.1016/j.asmr.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose The purpose of this study was to investigate the elongation of the biceps muscle tendon unit after rerouting of the long head of the biceps tendon without transection, with and without release of the transverse humeral ligament in a 3-dimensional model. Methods A total of 60 sets of computed tomography images of shoulders were acquired, and a point-cloud model was generated after 3-dimensional reconstruction. Simulation of rerouting of the long head of the biceps tendon was performed by assuming that the long head of the biceps tendon travels to the center of the greater tuberosity from the supraglenoid tubercle and then back to the bicipital groove distally, with or without the release of the transverse humeral ligament. The elongation of the biceps muscle tendon unit by both manners was measured and correlated with age, height, weight, body mass index, gender, and hand dominance. Results The mean length of the long head of the biceps tendon is 74.22 ± 3.06 mm, and the length is significantly longer, at 112.23 ± 4.92 mm (P = 0.0002) and 96.47 ± 2.58 mm (P = 0.0004). The absolute elongation of the biceps muscle tendon unit after rerouting of the long head of the biceps tendon, without or with transverse humeral ligament release, showed significant differences, which were 38.73 ± 3.03 mm and 22.28 ± 3.25 mm, respectively (P = 0.0008). No significant correlations were observed between the amount of the elongation and the subject's age, height, weight, or body mass index. No significant difference was observed in the amount of the elongation between differing gender and hand dominance. Conclusions Rerouting of the long head of the biceps tendon resulted in significant elongation of the biceps muscle tendon unit. Release of the transverse humeral ligament partially decreased this elongation. Clinical Relevance Rerouting of the long head of the biceps tendon may lead to overtension of the biceps. If it is adopted in clinical use, transverse humeral ligament release is recommended.
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Affiliation(s)
- Hailong Zhang
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Chunyan Jiang
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
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Effect of biceps rerouting technique to restore glenohumeral joint stability for large irreparable rotator cuff tears: a cadaveric biomechanical study. J Shoulder Elbow Surg 2020; 29:1425-1434. [PMID: 32081635 DOI: 10.1016/j.jse.2019.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/31/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The concept of stabilizing the humerus has taken on an important role in the treatment of irreparable cuff tears, and the biceps rerouting (BR) method is considered one of the most effective treatments in this field. The study aimed to evaluate the biomechanical effects of BR for large irreparable rotator cuff tears (LICTs). METHODS A total of 8 cadaveric shoulders were used for testing under 5 conditions: intact shoulder, LICT, partial repair (PR), BR, and biceps rerouting with side-to-side repair (BRSS). Total rotational range of motion was measured at 40°, then 20°, and finally 0° of glenohumeral (GH) abduction. Superior humeral translation and subacromial contact pressure were measured at 0°, 30°, 60°, and 90° of external rotation at each abduction angle. Repeated-measures analyses of variance with Tukey post hoc tests were used for statistical comparisons. RESULTS Superior humeral translation was significantly decreased in the BR and BRSS conditions compared with the LICT and PR conditions at 0° and 20° of GH abduction (P < .001). BR and BRSS significantly reduced subacromial contact pressure compared with LICT and PR at 0° of GH abduction (P < .001). There was no significant decrease in total rotational range of motion after BR at any abduction angle. CONCLUSION BR biomechanically restored shoulder stability without overconstraining range of motion in an LICT model.
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