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Stone MA, Parikh H, Foster L, Wright-Chisem A, Ewing B, Karimi AH, Langberg J. Proximal humerus open reduction internal fixation with and without biceps tenodesis: assessment of early clinical outcomes. JSES Int 2024; 8:751-755. [PMID: 39035658 PMCID: PMC11258823 DOI: 10.1016/j.jseint.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background The role of biceps tenodesis (BT) during open reduction internal fixation (ORIF) of proximal humerus fractures (PHFs) remains unclear. A subset of patients undergoing ORIF have persistent pain with unclear etiology. The purpose of our study was to compare outcomes of ORIF of PHFs with and without concomitant BT. We hypothesize patients undergoing BT at the time of ORIF will have improved patient-reported outcome scores with fewer secondary procedures related to treatment of the biceps. Methods In this retrospective cohort study, all patients undergoing ORIF for a PHF at a single level one trauma center from January 2019 to June 2022 were reviewed. Patients under the age of 18 were excluded. Primary outcomes were patient-reported outcomes measurement information system physical function, depression, and pain interference scores at 5 time points up to final follow-up. Secondary outcomes included total operative time, complications, subsequent procedures, steroid injections, and range of motion. Chi-square tests were performed for categorical values and paired t-tests for continuous variables. Results 71 patients met inclusion criteria: 41 undergoing ORIF without BT and 30 undergoing ORIF with BT. Average follow-up was 11 months. There were no statistically significant differences in patient demographics between groups. There were no differences in patient-reported outcomes measurement information system scores at any time point postoperatively. At final follow-up patients in the ORIF with BT group had higher forward flexion than those who did not undergo BT (142 vs. 123 degrees, respectively, P < .02). There were no differences in surgical time, revision rates, postsurgical complications, or postoperative injections between groups. Conclusion BT performed during ORIF of PHFs did not result in significantly different functional or patient-reported outcomes between groups, except for greater forward flexion at final follow-up. Although BT was done more commonly in severe PHFs, patients in both groups had similar rates of subsequent biceps-related procedures and revision surgery.
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Affiliation(s)
- Michael A. Stone
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harin Parikh
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lukas Foster
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adam Wright-Chisem
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brett Ewing
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Amir H. Karimi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joshua Langberg
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Herbert Wertheim College of Medicine, Miami, FL, USA
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Kuan FC, Hsu KL, Lin FH, Hong CK, Chen Y, Shih CA, Su WR. Biomechanical comparisons of all--suture suspensory button vs. interference screw for inlay subpectoral bicep tenodesis. J Shoulder Elbow Surg 2024:S1058-2746(24)00360-4. [PMID: 38762151 DOI: 10.1016/j.jse.2024.03.061] [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: 02/05/2024] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND All-suture buttons (ASBs) and interference screw (IS) are commonly utilized in the inlay subpectoral biceps tendon tenodesis. However, the biomechanical characteristics of these two methods have not been compared directly. The aim of present study was to compare the biomechanical properties of ASB vs. IS for inlay subpectoral biceps tendon tenodesis in a human cadaveric model. METHODS Sixteen fresh-frozen human cadaveric shoulders were randomly divided into two experimental inlay biceps tenodesis groups: ASB or IS. After tenodesis, every specimen was preloaded at 5 N for 2 minutes, followed with a cyclic loading test from 5 to 70 N for 500 load cycles. Then the load-to-failure test was performed. Afterward, the humerus was placed in a cylinder tube and secured with anchoring cement. Lastly, a two-point bending test was performed to determine the strength of the humerus. Destructive axial force was applied, and the failure strength and displacement were recorded. RESULTS No difference in stiffness was observed between the two groups (ASB = 27.4 ± 3.5 N/mm vs. IS = 29.7 ± 3.0 N/mm; P = .270). Cyclic displacement was significantly greater in the ASB group (6.8 ± 2.6 mm) than the IS group (3.8 ± 1.1 mm; P = .021). In terms of failure load, there were no statistical differences among the two groups (P = .234). The ASB group was able to withstand significantly greater displacement (11.9 ± 1.6 mm) before failure than the IS group (7.8 ± 1.5 mm; P = .001). During the humeral bending test, the ASB group exhibited significantly greater maximal load (2354.8 ± 285.1 N vs. 2086.4 ± 296.1 N; P = .046) and larger displacement (17.8 ± 2.8 mm vs. 14.1 ± 2.8 mm; P = .027) before fracture. CONCLUSIONS In inlay subpectoral bicep tenodesis, ASB fixation appears to offer comparable stiffness and failure load to that of IS fixation. Additionally, the ASB group exhibited greater resistance to load and displacement before humeral fracture. However, the ASB group did demonstrate increased cyclic displacement compared to IS group.
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Affiliation(s)
- Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fang-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Tainan Municipal An-Nan Hospital, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
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Kim S, Deivert KT, Goodeill T, Firoved AB, Morgan CN, Worcester KS, Kim W, Bonner KF. Concomitant Biceps Tenodesis Does Not Compromise Arthroscopic Rotator Cuff Repair Outcomes. Arthroscopy 2024:S0749-8063(24)00170-1. [PMID: 38479637 DOI: 10.1016/j.arthro.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To compare outcomes of patients who underwent rotator cuff repair (RCR) with concomitant biceps tenodesis with those who underwent an isolated RCR. METHODS Exclusion criteria included previous ipsilateral shoulder surgery, irreparable rotator cuff tears, rotator cuff arthropathy, calcific tendinitis, adhesive capsulitis requiring a capsular release, or advanced osteoarthritis of the glenohumeral joint. Patients were indicated for biceps tenodesis if they had any degree of tendon tearing, moderate-to-severe tenosynovitis, instability, or a significant degenerative SLAP tear. Primary outcome measures included American Shoulder and Elbow Surgeons score, Simple Shoulder Test, EuroQoL 5-Dimension 5-Level visual analog scale, EuroQoL 5-Dimension 5-Level, and a site-specific questionnaire, which focused on surgical expectations, satisfaction, and complications. Multivariate analysis of variance to analyze descriptive statistics and determine significant differences between the patient groups for subjective and objective outcome measures were performed. RESULTS There were no significant differences for pain/visual analog scale (0.34 ± 0.09 vs 0.47 ± 0.09, P = .31), American Shoulder and Elbow Surgeons score (96.69 ± 0.87 vs 94.44 ± 0.91, P = .07), and Simple Shoulder Test (11.42 ± 0.17 vs 10.95 ± 0.18, P = .06) between the RCR with concomitant biceps tenodesis and isolated RCR at a minimum of 2 years' postoperatively. This is despite the RCR with concomitant biceps tenodesis group having significantly larger rotator cuff tears (4.25 ± 0.30 cm2 vs 2.80 ± 0.32 cm2, P = .001) than the isolated RCR group. CONCLUSIONS This study revealed that concomitant biceps tenodesis does not compromise outcomes when compared with an isolated RCR at 2-year follow-up, despite this group having larger rotator cuff tears. LEVEL OF EVIDENCE Level III, retrospective case study.
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Affiliation(s)
- Samuel Kim
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A..
| | - Kyle T Deivert
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | | | - Amanda B Firoved
- Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - Caleb N Morgan
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Katherine S Worcester
- Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - William Kim
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Kevin F Bonner
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.; Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
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Quintana JO, Talamo M, Liddy N, Sygall K, Tomaszewski P, Miller S, Sethi PM. Evaluating clinical outcomes of two biceps tenodesis techniques: Loop 'N' Tack and subpectoral biceps tenodesis. JSES Int 2024; 8:274-277. [PMID: 38464437 PMCID: PMC10920143 DOI: 10.1016/j.jseint.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Purpose Biceps tenodesis is an effective surgical procedure that can address pathologies of the long head of the biceps tendon. The purpose of this study was to evaluate clinical outcomes following two different biceps tenodesis techniques: Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis. Hypothesis Patients undergoing both the subpectoral biceps tenodesis and Loop 'N' Tack biceps tenodesis will have improvements in patient-reported outcomes. Methods Hundred and sixty five consecutive patients who underwent biceps tenodesis were retrospectively identified and contacted by phone to collect visual analog scale pain scores, University of California, Los Angeles shoulder scores, Simple Shoulder Test scores, Single Assessment Numeric Evaluation scores, and American Shoulder and Elbow Surgeons scores. Range of motion, elbow flexion strength, and incidence of bicipital groove pain and Popeye deformity were recorded. Results One Hundred and forty five patients were included in the study (55 subpectoral, 90 Loop 'N' Tack). Patients in both groups reported high American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California, Los Angeles, Single Assessment Numeric Evaluation shoulder function scores, low visual analog scale pain scores, and had a minimal risk of complications when measured one year postoperatively. Conclusion Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis techniques are reliable and effective procedures that can reduce pain scores and restore shoulder function when patients require surgical intervention.
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Affiliation(s)
- Julio Ojea Quintana
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Michael Talamo
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Nicole Liddy
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Kyle Sygall
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Paul Tomaszewski
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Seth Miller
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
| | - Paul M. Sethi
- Orthopaedic & Neurosurgery Specialists Foundation for Clinical Research and Education, ONSF, Greenwich, CT, USA
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Glover MA, Restrepo A, Recker AJ, Beck EC, Bullock GS, Trasolini NA, Waterman BR. An Expedited Sling Immobilization Protocol After Isolated Biceps Tenodesis Results in Clinical and Patient-Reported Postoperative Outcomes Equivalent to a Standard Rehabilitation Protocol. Arthrosc Sports Med Rehabil 2024; 6:100840. [PMID: 38187952 PMCID: PMC10770724 DOI: 10.1016/j.asmr.2023.100840] [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: 07/19/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose To characterize clinical and patient-reported outcomes for patients after isolated biceps tenodesis (BT) who underwent either standard or expedited sling immobilization protocols following surgery. Methods This retrospective cohort study compared patients who were assigned to use a sling for either 4 to 6 weeks (standard) or 0 to 2 weeks (expedited) following an isolated BT. Primary endpoint included rate of re-rupture, surgical revision, loss of fixation, and Popeye deformity. Secondary endpoints included shoulder range of motion (ROM) as well as pre- and postoperative patient-reported outcomes (PROs) of pain and function. Missing data were managed via multiple imputation with chained equations. Complication prevalence 95% confidence intervals were calculated using the Clopper Pearson method and a series of hierarchical mixed effects linear regressions were performed to assess differences between sling interventions in PROs and ROM. Results The average age of the standard cohort (n = 66) was 49 years (±14 years), and the average age of the expedited cohort (n = 69) was 47 years (±14 years). The expedited and standardized cohorts demonstrated 0.4 and 0.3 complications per 10,000 exposure days, respectively, with no significant difference between groups (1.4 [95% confidence interval 0.2-10.0], P = .727). There was no demonstrated difference in forward flexion, abduction, or external ROM. The expedited group had less improvement in visual analog scale for pain scores that was not clinically significant and there were no differences in PROs of function. Conclusions No statistically significant difference in the rate of re-rupture, surgical revision, loss of fixation, or Popeye deformity was noted between protocols after isolated BT. Furthermore, there were no clinically significant differences in ROM or PROs identified between protocols after isolated BT. This study suggests that patients who have undergone isolated BT may safely discontinue sling use within 2 weeks after surgery. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Mark A. Glover
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Alexis Restrepo
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Andrew J. Recker
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Edward C. Beck
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Garrett S. Bullock
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Nicholas A. Trasolini
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Brian R. Waterman
- Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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Makovicka JL, Brinkman JC, Benner N, Tokish AJ, Moore ML, Tokish JM. All-Arthroscopic Falciform Portal Biceps Tenodesis. Arthrosc Tech 2024; 13:102842. [PMID: 38435253 PMCID: PMC10907896 DOI: 10.1016/j.eats.2023.09.017] [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: 07/25/2023] [Accepted: 09/20/2023] [Indexed: 03/05/2024] Open
Abstract
Biceps tenodesis has been proven to be an effective treatment for biceps tendon and superior labral pathology. Many techniques including both open and arthroscopic approaches have been reported. Open techniques afford management of the entire proximal biceps tendon but are limited by wound healing issues, increased bleeding, and increased surgical time. Arthroscopic tenodesis offers benefits in terms of surgical efficiency, cosmesis, and bleeding risk. However, standard arthroscopic tenodesis only addresses intra-articular biceps pathology. In this report we describe an all-arthroscopic biceps tenodesis technique at the suprapectoral region of the humerus using knotless suture anchor fixation.
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Affiliation(s)
| | | | - Nathan Benner
- Department of Orthopedic Surgery, University of Washington, Seattle, Washington
| | - Aiden J. Tokish
- Mayo Clinic Arizona Department of Orthopedic Surgery, Phoenix, Arizona
| | - M. Lane Moore
- Mayo Clinic Arizona Department of Orthopedic Surgery, Phoenix, Arizona
| | - John M. Tokish
- Mayo Clinic Arizona Department of Orthopedic Surgery, Phoenix, Arizona
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7
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Perry NPJ, Smith J, Hurvitz A, Baglien P, Nascimento R. Editorial Commentary: Shoulder Long Head of the Biceps Tendon Transposition Without Tenotomy May Be a Beneficial Augment for Massive Rotator Cuff Tear Repair. Arthroscopy 2024; 40:55-57. [PMID: 38123273 DOI: 10.1016/j.arthro.2023.07.022] [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: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 12/23/2023]
Abstract
Although many surgeons discard the long head of the biceps (LHB) tendon during arthroscopic rotator cuff repairs, several authors have argued that the LHB tendon may serve as a biologic and structural augment for massive repairs. There are multiple benefits of incorporating the LHB tendon autograft in difficult-to-repair massive rotator cuff tears. First, by maintaining the glenoid origin, the tendon likely retains a significant native blood supply, as well as tenocytes, which may support the healing process. In addition, there are several biomechanical benefits. The LHB may act as a dynamic humeral head depressor since it is still attached to the muscular unit distally. The tendon could also serve as a convergence post, while proving robust tissue for the repair. Also, the LHB tendon may decrease undue tension on the repair, bringing us closer to a tension-free repair. Finally, this may be a cost-conscious technique. One concern, requiring additional investigation, is that some surgeons believe the LHB may be a pain generator in patients with rotator cuff tears. One surgeon's trash is another surgeon's treasure.
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Affiliation(s)
- Nicholas P J Perry
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jennifer Smith
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California, U.S.A
| | - Andrew Hurvitz
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California, U.S.A
| | - Peter Baglien
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California, U.S.A
| | - Robert Nascimento
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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8
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Teo BJX, Yew A, Tan MWP, Chou SM, Lie DTT. The double-lasso loop technique of Biceps tenodesis has lower displacement after cyclic loading, compared to interference screw fixation: Biomechanical analysis in an ovine model. Shoulder Elbow 2023; 15:602-609. [PMID: 37981968 PMCID: PMC10656979 DOI: 10.1177/17585732221095766] [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: 01/02/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2023]
Abstract
Background Biceps tenodesis is an effective treatment for symptomatic long head of biceps tendon pathology. Recently the arthroscopic "double lasso-loop" suture anchor (DLSA) technique was described, advantaged by reduced cost, complexity, and operative time. We aimed to compare the in vitro strength of DLSA with conventional interference screws (IS). Methods A biomechanical analysis was conducted on 14 sheep shoulders (8 DLSA, 6 IS), consisting of a 500-cycle cyclic loading experiment of 5-70 N and ultimate failure load (UFL) test where each specimen was pulled until failure. Displacement (mm) was recorded every 100 cycles, while stiffness and UFL were observed. Results Cyclic displacement was significantly lower with DLSA at 100 cycles, but not above. During the UFL test, IS was stiffer (27.68 ± 6.56 N/mm versus 14.10 ± 5.80 N/mm, p = .005) and had higher UFL (453.67 ± 148.55 N versus 234.22 ± 44.57 N, p = .001) than DLSA. All DLSA failures occurred with suture/anchor pull-out, while all IS constructs failed at the muscle/tendon. Discussion Comparison of the novel DLSA technique with a traditional IS method found lower initial displacement. While our IS constructs could withstand higher UFL, peak load characteristics of DLSA were similar to previous ovine studies. Hence, the DLSA technique is a viable alternative to IS for biceps tenodesis with its purported non-biomechanical advantages.
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Affiliation(s)
- Bryon JX Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Andy Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Marcus Wei Ping Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Siaw Meng Chou
- School of Mechanical & Aerospace Engineering, College of Engineering, Nanyang Technological University, Singapore, Singapore
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Wang H, Huddleston HP, Kurtzman JS, Gedailovich S, Deegan L, Aibinder WR. Subpectoral proximal humeral anatomy: Guidance to decrease risk of fracture following subpectoral biceps tenodesis. Shoulder Elbow 2023; 15:647-652. [PMID: 37981963 PMCID: PMC10656969 DOI: 10.1177/17585732231159392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/13/2022] [Accepted: 02/07/2023] [Indexed: 11/21/2023]
Abstract
Background Biceps tenodesis is used for a variety of shoulder and biceps pathologies. Humeral fracture is a significant complication of this procedure. This cadaveric anatomy study sought to determine the cortical thickness of the humeral proximal shaft to identify the optimal technique to decrease unicortical drilling and reduce the risk of fracture. Methods A computed tomography (CT) of eight cadaveric humeral specimens was obtained with a metallic marker placed at the site of subpectoral tenodesis. These scans were examined to define the cortical thickness of the subpectoral region of the humerus and determine angular safe zones for reaming. Results At the standard point of a subpectoral tenodesis, a mean angle relative to the coronal plane of 29.2° medially and 21.6° laterally from the deepest portion of the bicipital groove avoided unicortical drilling with a 7 mm reamer. These values varied slightly 1 cm proximal and distal to this level. The thickest regions of cortex in the subpectoral humerus correspond to the ridges of the bicipital groove. Discussion To avoid unicortical tunnels, surgeons should limit deviation from the perpendicular approach to no more than 23° relative to the coronal plane medially and 11° relative to the coronal plane laterally.
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Affiliation(s)
- Hanbin Wang
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Hailey P Huddleston
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Joey S Kurtzman
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Samuel Gedailovich
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Liam Deegan
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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10
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Light JJ, du Plessis W, Adsit MH, Eckstrom AT, Firoved AB, Griffin JW, Bonner KF. Mild Biceps Tendonitis May Be Managed Nonoperatively During Shoulder Arthroscopy. Arthrosc Sports Med Rehabil 2023; 5:100785. [PMID: 37753186 PMCID: PMC10518440 DOI: 10.1016/j.asmr.2023.100785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose The purposes of this study were to determine whether patients with mild biceps tendonitis required revision surgery after the biceps tendon was not surgically treated, while addressing concomitant pathology, and to evaluate whether preoperative groove pain affected patient-reported outcomes. Methods Patients who underwent shoulder arthroscopy between 2015 and 2018 by a single surgeon for rotator cuff pathology, debridement, and distal clavicular excision (DCE), with or without subacromial decompression (SAD), and where the biceps tendon was not surgically addressed were retrospectively identified. Inclusion criteria were mild LS (<50% hyperemic appearing biceps tendon arthroscopically), and a minimum 2-year follow-up. The primary outcome measure was the incidence of revision surgery. Secondary outcomes included American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), pain level, and satisfaction scores. Two sample t-tests compared postoperative patient-reported outcomes based on the presence or absence of preoperative bicipital groove tenderness. Results Sixty-four of 69 eligible subjects (93%) were evaluated at a minimum of 2 years postoperatively. One out of 64 subjects underwent revision to perform a biceps tenodesis. Overall, patients had high patient-reported outcome measures (PROMs) postoperatively. Ninety-seven percent of patients reported they would have the surgery again. The presence of preoperative bicipital groove tenderness had no effect on ASES (P = .62), SST (P = .83) scores, and postoperative pain (P = .65). Patients without bicipital groove pain had average respective ASES and SST scores of 93.70 ± 11.84 and 10.66 ± 2.47; those with bicipital groove pain averaged 92.00 ± 15.31 and 10.78 ± 1.87. There was no significant difference in overall satisfaction scores between patients with groove pain (9.42 ± 1.40) and those without (9.46 ± 1.38; P = .92). Conclusions Patients with mild biceps tendonitis showed favorable outcomes with low revision rates and high patient satisfaction when the biceps tendon was not surgically addressed when the primary shoulder pathology was treated during arthroscopy, independent of preoperative groove pain. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
| | - Wihan du Plessis
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
- Ohio Health-Riverside Methodist Hospital, Columbus, Ohio, U.S.A
| | - Matthew H. Adsit
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | | | - Amanda B. Firoved
- Jordan-Young Institute for Orthopedic Surgery & Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - Justin W. Griffin
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
- Jordan-Young Institute for Orthopedic Surgery & Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - Kevin F. Bonner
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
- Jordan-Young Institute for Orthopedic Surgery & Sports Medicine, Virginia Beach, Virginia, U.S.A
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Clinker C, Simister SK, Thomas L, Da Silva A, Ishikawa H, Joyce C, Chalmers PN, Tashjian RZ. Revision Subpectoral Biceps Tenodesis Demonstrates a High Patient Satisfaction and Good Functional Outcomes. Arthrosc Sports Med Rehabil 2023; 5:100797. [PMID: 37746319 PMCID: PMC10511333 DOI: 10.1016/j.asmr.2023.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/04/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose To clinically evaluate a subset of patients who underwent a revision subpectoral biceps tenodesis for a clinically failed proximal biceps tenodesis. Methods This is a retrospective case series of patients with at least 2-year follow-up who had undergone a revision biceps tenodesis after clinical failure of a proximal biceps tenodesis between January 2008 and February 2020 by a single surgeon. Patients who underwent concomitant procedures, such as revision cuff repair, were excluded. Patients with a minimum of 2 years duration status postrevision subpectoral tenodesis were contacted for informed consent and outcome data, which included Simple Shoulder Test, American Shoulder and Elbow Surgeons score, visual analog scale for pain, and subjective reporting of arm weakness and satisfaction. Results Fourteen patients were initially identified as meeting inclusion criteria with a minimum 2-year follow-up achieved for 11 of 14 patients (78.5% follow-up). The mean follow-up time was 8.1 years (range, 2.7-14.8 years). After the primary biceps tenodesis, a mean of 8.0 ± 9.6 months passed before the revision subpectoral biceps tenodesis was performed. The average postoperative active forward elevation and adducted external rotation were 159 ± 7° and 47 ± 17°, respectively. The mean ± standard deviation (range) follow-up American Shoulder and Elbow Surgeons score was 79 ± 23 (30-100), Simple Shoulder Test was 11 ± 2 (7-12), and visual analog scale for pain was 2.6 ± 2.8 (0-9). All 11 patients reported being satisfied with their operation and would elect to have the operation again. Conclusions Revision subpectoral biceps tenodesis is a viable procedure for addressing patients with persistent pain following initial proximal biceps tenodesis. Although some persistent pain is common, revision subpectoral biceps tenodesis demonstrates a high patient satisfaction and good functional outcomes. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Christopher Clinker
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Samuel K. Simister
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Logan Thomas
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Adrik Da Silva
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Hiroaki Ishikawa
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Christopher Joyce
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Peter N. Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Robert Z. Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
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Franceschetti E, Giovannetti de Sanctis E, Palumbo A, Paciotti M, La Verde L, Maffulli N, Franceschi F. The management of the long head of the biceps in rotator cuff repair: A comparative study of high vs. subpectoral tenodesis. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:613-618. [PMID: 32791203 PMCID: PMC10466182 DOI: 10.1016/j.jshs.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Tenodesis of the long head of the biceps (LHB) is commonly undertaken during arthroscopic rotator cuff repair. We assessed the clinical and structural outcomes after high arthroscopic tenodesis (HAT) or mini-open subpectoral tenodesis (ST). We hypothesized that the clinical and structural results after HAT and ST are similar. METHODS We included 40 patients with rotator cuff tear and LHB tendinopathy. Twenty patients (7 women and 13 men; mean age: 57.9 years; range: 56-63 years) were treated using HAT, and 20 patients (8 women and 12 men; mean age: 58.5 years; range: 55-64 years) were treated using ST. Functional evaluation was performed preoperatively and at 6 weeks, 6 months, and 1 year after surgery, using the Constant Murley Score and Simple Shoulder Test scores; the LHB was evaluated using the LHB score. A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery. RESULTS The postoperative total and pain subscale's Constant scores were significantly higher in the ST group. Moreover, 2 LHB score values were significantly different between the groups. The postoperative LHB total score in the ST and HAT groups averaged 86.9 ± 4.1 (mean ± SD) points and 73.3 ± 6.4 points, respectively. The Pain/Cramps subscale in the ST and HAT groups averaged 47.1 ± 5.9 and 33.2 ± 4.6 points, respectively. The 2 groups showed no difference in Visual Analogue Scale values (5.5 in the HAT group; 5.8 in the ST group) postoperatively. One patient in the HAT group reported a secondary onset of Popeye deformity. CONCLUSION Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results, but the ST group was associated with better postoperative clinical outcomes.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00100 Rome, Italy
| | | | - Alessio Palumbo
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00100 Rome, Italy
| | - Michele Paciotti
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00100 Rome, Italy
| | - Luca La Verde
- Anca Surgical Center, Via Francesco Maidalchini 20, Roma, 00152, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Via Salvador Allende, 43, 84081 Baronissi, Salerno, Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST4, England, UK.
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00100 Rome, Italy
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Forsythe B, Patel HH, Berlinberg EJ, Forlenza EM, Okoroha KR, Williams BT, Yanke AB, Cole BJ, Verma NN. A Radiostereometric Analysis of Tendon Migration After Arthroscopic and Mini-Open Biceps Tenodesis: Interference Screw Versus Single Suture Anchor Fixation. Am J Sports Med 2023; 51:2869-2880. [PMID: 37548005 DOI: 10.1177/03635465231187030] [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] [Indexed: 08/08/2023]
Abstract
BACKGROUND Studies suggest that similar clinical results are achieved via arthroscopic and open biceps tenodesis (BT) techniques. PURPOSE To quantify the postoperative migration of the BT construct between arthroscopic suprapectoral BT (ASPBT) and open subpectoral BT (OSPBT) techniques via interference screw (IS) or single-suture suture anchor (SSSA) fixation using radiostereometric analysis. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Distal migration of the biceps tendon after OSPBT with a polyetheretherketone IS, OSPBT with 1 SSSA, ASPBT with polyetheretherketone IS, and ASPBT with 2 SSSAs was measured prospectively. Patients with symptomatic biceps tendinopathy and preoperative patient-reported outcome measures (PROMs) including Constant-Murley subjective, Single Assessment Numeric Evaluation, or Patient-Reported Outcomes Measurement Information System-Upper Extremity scores were included. A tantalum bead was sutured on the proximal end of the long head of the biceps tendon before fixation of tendon tissue. Anteroposterior radiographs were performed immediately postoperatively, at 1 week, and at 3 months. Bead migration was measured, and preoperative PROMs were compared with those at latest follow-up. RESULTS Of 115 patients, 94 (82%) were available for final follow-up. IS fixation yielded the least tendon migration with no difference between the open and arthroscopic approaches (4.31 vs 5.04 mm; P = .70). Fixation with 1 suture anchor demonstrated significantly greater migration than that achieved with an IS at both 1 week (6.47 vs 0.1 mm, 6.47 vs 1.75 mm, P < .001;) and 3 months (14.76 vs 4.31 mm, 14.76 vs 5.04 mm, P < .001) postoperatively. Two-suture anchor fixation yielded significantly greater migration than IS fixation at 1 week (7.02 vs 0.1 mm, P < .001; 7.02 vs 1.75 mm, P = .003) but not 3 months postoperatively (8.06 vs 4.31 mm, P = .10; 8.06 vs 5.04 mm, P = .07). Four patients with suture anchor fixation (3 patients in the OSPBT 1 SSSA group, 9.4%, and 1 patient in the ASPBT 2 SSSAs group, 3.8%) developed a Popeye deformity, whereas no Popeye deformities occurred in the IS groups. Mean 3-month bead migration in patients with and without a Popeye deformity was 60.8 and 11.2 mm, respectively (P < .0001). PROMs did not differ among groups at final follow-up. CONCLUSION Interference screw fixation yielded the least tendon migration whether achieved arthroscopically or open. The available data indicated that fixation with 1 SSSA but not 2 SSSAs resulted in significantly greater migration than that achieved with an IS. Despite variations in tendon migration, PROMs were similar among all groups. When SSSAs are used, tendon migration may be minimized by using ≥2 anchors.
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Affiliation(s)
| | - Harsh H Patel
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | | | | | - Kelechi R Okoroha
- Mayo Clinic Orthopedics and Sports Medicine, Minneapolis, Minnesota, USA
| | - Brady T Williams
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
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Godinho AC, Almeida FSD, Ayres JCZ, Godinho PC, Godinho GG, Sugawara MJT. Translation and Cultural Adaptation to Portuguese of the Long Head of Biceps Tendon Score. Rev Bras Ortop 2023; 58:471-477. [PMID: 37396075 PMCID: PMC10310427 DOI: 10.1055/s-0042-1750825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/28/2022] [Indexed: 10/17/2022] Open
Abstract
Objective To translate and culturally adapt the Long Head of Biceps Tendon (LHB) score into Brazilian Portuguese. Methods The process involved translations by professionals fluent in the target language, followed by independent back translations. Next, a committee compared the original and translated versions, pretested the final version, and concluded it. Results We translated and adapted the questionnaire according to the proposed methodology. In the first version in Portuguese (VP1) there was divergence regarding the translation of twelve terms. Compared to the original version, the back translation of VP1 presented eight diverging terms. A committee prepared a second version in Portuguese (VP2) and applied it to a pretest group consisting of 30 participants. Finally, we conceived the third version in Portuguese, called LHB-pt. Conclusion The translation and cultural adaptation into Brazilian Portuguese of the LBH score was successfully accomplished.
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Affiliation(s)
- André Couto Godinho
- Serviço de Cirurgia do Ombro, Hospital Ortopédico, Belo Horizonte, Minas Gerais, Brasil
| | | | | | - Pedro Couto Godinho
- Serviço de Cirurgia do Ombro, Hospital Ortopédico, Belo Horizonte, Minas Gerais, Brasil
| | | | - Marcel Jun Tamaoki Sugawara
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil
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Drain NP, Greiner JJ, Simonian LE, Carlos NBT, Hyre ND, Smith C, Hughes JD, Lin A, Lesniak BP. Depressive and Anxiety Disorders Increase Risk for Recurrent Anterior Shoulder Pain Following Arthroscopic Suprapectoral Biceps Tenodesis. Arthrosc Sports Med Rehabil 2023; 5:e739-e749. [PMID: 37388874 PMCID: PMC10300603 DOI: 10.1016/j.asmr.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/05/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To evaluate factors associated with postoperative anterior shoulder pain following arthroscopic suprapectoral biceps tenodesis (ABT) and to determine the clinical impact of postoperative anterior shoulder pain. Methods A retrospective study of patients that underwent ABT between 2016 and 2020 was conducted. Groups were categorized by the presence (ASP+) or absence (ASP-) of postoperative anterior shoulder pain. Patient-reported outcomes (American Shoulder and Elbow score [ASES], visual analog scale [VAS] for pain, subjective shoulder value [SSV]), strength, range of motion, and complication rates were analyzed. Differences between continuous and categorical variables were tested with two-sample t-tests and chi-squared or Fisher's exact tests, respectively. Variables collected at different postoperative timepoints were analyzed using mixed models with post hoc comparisons when significant interactions were detected. Results A total of 461 (47 ASP+, 414 ASP-) patients were included. A statistically significant lower mean age was observed in the ASP+ group (P < .001). A statistically significant higher prevalence of major depressive disorder (MDD) (P = .03) or any anxiety disorder (P = .002) was observed in the ASP+ group. Prescription medication with psychotropic medications (P = .01) was significantly more prevalent in the ASP+ group. No significant differences were observed in the proportion of individuals reaching the minimal clinical important difference (MCID) for ASES, VAS, or SSV between groups. Conclusions A pre-existing diagnosis of major depressive disorder or any anxiety disorder, as well as the use of psychotropic medications was associated with postoperative anterior shoulder pain following ABT. Other factors associated with anterior shoulder pain included younger age, participation in physical therapy before surgery, and lower rate of concomitant rotator cuff repair or subacromial decompression. Although the proportion of individuals reaching MCID did not differ between groups, the presence of anterior shoulder pain after ABT resulted in prolonged recovery, inferior PROs, and a higher incidence of repeat surgical procedures. The decision to perform ABT in patients diagnosed with MDD or anxiety should be carefully considered, given the correlation to postoperative anterior shoulder pain and inferior outcomes. Level of Evidence Level III, retrospective case-control study.
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Affiliation(s)
- Nicholas P. Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Justin J. Greiner
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Lauren E. Simonian
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Noel Bien T. Carlos
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Nathan D. Hyre
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Clair Smith
- Department of Physical Therapy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Pittsburgh Shoulder Institute, Pittsburgh, Pennsylvania, U.S.A
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Pittsburgh Shoulder Institute, Pittsburgh, Pennsylvania, U.S.A
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Pittsburgh Shoulder Institute, Pittsburgh, Pennsylvania, U.S.A
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16
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Guerra JJ, Curran GC, Guerra LM. Subpectoral, Suprapectoral, and Top-of-Groove Biceps Tenodesis Procedures Lead to Similar Good Clinical Outcomes: Comparison of Biceps Tenodesis Procedures. Arthrosc Sports Med Rehabil 2023; 5:e663-e670. [PMID: 37388890 PMCID: PMC10300542 DOI: 10.1016/j.asmr.2023.03.007] [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: 07/26/2022] [Accepted: 03/23/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To determine whether there is a difference in clinical results among open subpectoral (SB), arthroscopic low-in-groove suprapectoral (SP), and arthroscopic top-of-groove (TOG) locations in terms of patient-reported outcome measures for biceps tenodesis (BT) procedures using a global, self-reporting registry. Methods We identified patients who underwent BT surgery in the Surgical Outcomes System registry. The inclusion criteria were isolated primary surgical procedures for BT, excluding patients with rotator cuff and labral repairs. Additional search requirements included repair location and 100% compliance with pretreatment and 2-year follow-up surveys. This study measured clinical outcomes comparing the 3 aforementioned techniques using the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and Single Assessment Numeric Evaluation (SANE) score before treatment and at 3 months, 6 months, 1 year, and 2 years postoperatively. In addition, postoperative VAS pain scores were collected at 2 and 6 weeks. Statistical analysis was conducted using analysis of variance (Kruskal-Wallis test) and the Wilcoxon test. Results A total of 1,923 patients from the Surgical Outcomes System registry qualified for the study; of these, 879 underwent the SB technique, 354 underwent the SP technique, and 690 underwent the TOG technique. There was no statistically significant difference in the demographic characteristics among the groups except that the TOG group was older: 60.76 years versus 54.56 years in the SB group and 54.90 years in the SP group (P < .001). In all groups, the ASES score statistically improved from before treatment (mean, 49.29 ± 0.63) to 2 years postoperatively (mean, 86.82 ± 0.80; P < .05). There were no statistically significant differences among the 3 groups in the VAS, ASES, and SANE scores at all time points (P > .12) except for the VAS score at 1 year (P = .032) and the ASES score at 3 months (P = .0159). At 1 year, the mean VAS score in the SB group versus the TOG group was 1.146 ± 1.27 versus 1.481 ± 1.62 (P = .032), but the minimal clinically important difference (MCID) was not met. The 3-month ASES Index scores in the SB, SP, and TOG groups were 68.991 ± 18.64, 66.499 ± 17.89, and 67.274 ± 16.9, respectively (P = .0159), and similarly, the MCID was not met. At 2 years, the ASES scores in the SB, SP, and TOG groups improved from 49.986 ± 18.68, 49.54 ± 16.86, and 49.697 ± 7.84, respectively, preoperatively to 86.00 ± 18.09, 87.60 ± 17.69, and 86.86 ± 16.36, respectively, postoperatively (P > .12). Conclusions The SB, SP, and TOG BT procedures each resulted in excellent clinical improvement based on patient-reported outcome measures from a global registry. On the basis of the MCID, no technique was clinically superior to the other techniques in terms of VAS, ASES, or SANE scores at any time point up to 2 years. Level of Evidence Level III, retrospective comparative study.
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17
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Kreulen RT, Agarwal AR, Nayar SK, Wang KY, Miller AS, Best MJ, Srikumaran U. SLAP repair and bicep tenodesis: a comparison of utilization and revision rates for SLAP tears. JSES Int 2023; 7:290-295. [PMID: 36911775 PMCID: PMC9998736 DOI: 10.1016/j.jseint.2022.11.001] [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: 12/14/2022] Open
Abstract
Hypothesis The management of superior labrum anterior to posterior (SLAP) tears typically consists of either repair or biceps tenodesis (BT). While repair is more frequently recommended in younger patients, patients older than 40 years are often treated with BT. The purpose of this study is to determine whether there has been a change in utilization of these procedures over the past decade with respect to patient age as well as compare reoperation rates between the two procedures. Methods The Pearldiver database was queried to identify BT and SLAP repairs indicated for SLAP tears performed from 2010 to 2019. The primary outcome was utilization rate, stratified by age. A secondary outcome was 2-year shoulder reoperation rates. Trends were reported in terms of compounded annual growth rate. Outcome analysis was conducted using univariate and multivariable analysis. Results From 2010 to 2019, SLAP repair was the most common procedure performed for SLAP tears. Regardless of age, BT performed for SLAP tear had a significantly increased utilization rate; whereas, SLAP repair had a significantly decreased utilization rate. SLAP repair was more commonly performed in younger patients compared to BT. Following multivariable analysis, patients who underwent SLAP repair had significantly higher odds (odds ratio (OR): 1.453; 95% confidence interval (CI): 1.26-1.68; P < .001) of requiring an arthroscopic reoperation within 2 years when compared to those who underwent BT with no significant difference with respect to 2-year open reoperation. Conclusion Although SLAP repair is still more commonly used to treat SLAP tears than BT, especially for younger patients, the utilization of SLAP repair is decreasing while BT is increasing. The increased utilization of BT may be associated with lower rates of shoulder reoperation for problematic SLAP tears.
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Affiliation(s)
| | | | | | | | | | | | - Uma Srikumaran
- Johns Hopkins Hospital, Baltimore, MD, USA
- Corresponding author: Uma Srikumaran, MD, MBA, MPH, Johns Hopkins Orthopaedic Surgery at Howard County General Hospital, 10700 Charter Drive, Suite 310, Columbia, MD 21044, USA.
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Biceps Tenodesis in Patients Age 35 Years and Younger Yields Favorable Clinical Outcomes With Variable Rates of Return to Sport and Complications: A Systematic Review. Arthroscopy 2023; 39:830-837. [PMID: 36528216 DOI: 10.1016/j.arthro.2022.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/08/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To systematically evaluate reported clinical outcomes, return-to-sport (RTS) rates, and complications following biceps tenodesis in patients aged 35 years and younger and compare outcomes between overhead and nonoverhead athletes. METHODS A literature search was performed by querying Scopus, EMBASE, and PubMed computerized databases from database inception through August 2022 in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies that evaluated clinical outcomes following biceps tenodesis in patients aged 35 years or younger were included. Study quality was assessed via the Methodological Index for Non-Randomized Studies criteria. Clinical outcomes, RTS rates, and complications were aggregated. RESULTS Nine studies from 2011 to 2022 comprising 161 patients (mean age, 25 years; range, 19.7-28.9 years) were included. At an average follow-up of 59 months, postoperative American Shoulder and Elbow Surgeons score ranged from 81.6 to 96 and the mean visual analog scale score ranged from 0 to 2.1. Mean overall RTS rate ranged from 35% to 100% for the entire patient cohort 35% to 86% among overhead athletes, and 46% to 100% among nonoverhead athletes. Among the overhead athletes, 24 were baseball pitchers. 17% to 100% able to return to sport at any level. Complications were reported in 0% to 19% of patients. 0 to 18% of patients underwent revision surgery. CONCLUSIONS Biceps tenodesis in patients 35 years of age and younger yields a wide variability in reported RTS rates, excellent clinical outcome scores, and low but variable reported rates of complications, reoperations, and failure. LEVEL OF EVIDENCE IV; Systematic Review of Level III and IV studies.
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Shin MH, Baek S, Kim TM, Kim H, Oh KS, Chung SW. Biceps Tenodesis Versus Superior Labral Anterior and Posterior (SLAP) Lesion Repair for the Treatment of SLAP Lesion in Overhead Athletes: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3987-3997. [PMID: 34591715 DOI: 10.1177/03635465211039822] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior labral anterior and posterior (SLAP) lesions are common injuries in overhead athletes. As a surgical treatment for SLAP lesions, SLAP repair has been traditionally performed. Recently, biceps tenodesis has been performed as an alternative treatment option; however, there is no review for outcome comparisons between these 2 procedures in overhead athletes. PURPOSE The aim of this study was to compare the outcomes of SLAP repair versus biceps tenodesis, especially in overhead athletes with SLAP lesions. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS An electronic literature search was performed in Medline, Embase, Scopus, and the Cochrane Library. The studies were appraised using the Methodological Index for Non-randomized Studies (MINORS) tool. Studies that had a minimum follow-up of 2 years, included only patients with SLAP lesions without other major shoulder pathologies, and included only patients who engaged in overhead sports were included. The functional outcomes of the American Shoulder and Elbow Surgeons (ASES) score, rate of return to sport, rate of return to preinjury level of sport, and complication rate were subjected to meta-analysis. RESULTS A total of 332 articles were identified, and 13 were included in the systematic review. Even though the postoperative ASES scores were slightly higher in the biceps tenodesis group than in the SLAP repair group, no statistically significant differences were found between the groups (biceps tenodesis, 95% CI = 91.71-96.75, I2 = 0.00; SLAP repair, 95% CI = 85.47-94.46, I2 = 16.3; P = .085) The rate of return to sport and the return to preinjury level of sport were slightly higher in the biceps tenodesis group than in the SLAP repair group; however, in meta-analysis these factors did not reach statistical significance (return to sport: biceps tenodesis, 95% CI = 0.66-0.91, I2 = 0.00; SLAP repair, 95% CI = 0.68-0.93, I2 = 70.23; P = .94) (return to preinjury level of sport: biceps tenodesis, 95% CI = 0.61-0.89, I2 = 17.78; SLAP repair, 95% CI = 0.53-0.82, I2 = 58.07; P = .37). The biceps tenodesis group showed a lower complication rate compared with the SLAP repair group without statistical significance (biceps tenodesis, 95% CI = 0.013-0.145, I2 = 0.00; SLAP repair, 95% CI = 0.049-0.143, I2 = 0.00; P = .25). CONCLUSION The results of biceps tenodesis, compared with SLAP repair, were not inferior in the surgical treatment of overhead athletes with SLAP lesions with regard to the ASES score, rate of return to sport, rate of return to preinjury level of sport, and complication rate. Further high-level, randomized controlled studies are needed to confirm this result.
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Affiliation(s)
- Myung Ho Shin
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - Samuel Baek
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - HyunTae Kim
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
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Alghamdi AA, Althaqafi RMM, Babaier YH, Singer MS, Assiri S, Aljohani B, Alghamdi FA, Abdel Badie A. Clinical Outcomes of Long Head Biceps Tendinitis Treatment by a Semitenodesis Technique. Cureus 2022; 14:e31430. [DOI: 10.7759/cureus.31430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/15/2022] Open
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Harte LM, Rick T, Bisson LJ, Inglis S, Marzo JM. Clinical implications of the distinct anatomy and innervation of the long head biceps tendon. J Anat 2022; 241:453-460. [PMID: 35578947 PMCID: PMC9296028 DOI: 10.1111/joa.13685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 01/14/2023] Open
Abstract
The proximal long head of the biceps tendon (LHBT) has been recognized as a well-known cause of anterior shoulder pain. Previous studies have identified a heterogeneous distribution of nerve fibers in the tendon, with a higher abundance of fibers in the proximal and distal thirds of the tendon. This suggests that the proximal portion of the long head biceps tendon may have a different source of innervation than the distal portion. The purpose of this study was to review the innervation of the superior shoulder and identify the proximal source of sensory innervation of the LHBT. The relevant hypothesis was that the suprascapular nerve (SSN) was the proximal source of sensory innervation to the LHBT. Gross and microdissection of eight fresh human cadaver shoulders were performed, with a focus on the distal articular branches of suprascapular nerve (SSN). Utilizing 3.5× magnification loupes, the medial subacromial branch (MSAb), lateral subacromial branch (LSAb), and posterior glenohumeral branch (PGHb) were identified and followed distally to their terminal branches. In all specimens, terminal branches of the lateral subacromial branch supplied the proximal LHBT and the superior labrum. Terminal branches of the posterior glenohumeral branch supplied the posterosuperior labrum and, to a lesser extent, the labral attachment of the LHBT. These findings confirm branches of the suprascapular nerve as the proximal source of sensory innervation to the LHBT. Identification of the suprascapular nerve as a source of proximal innervation of the LHBT may influence clinical decisions related to nonsurgical and surgical intervention, nerve blocks, and nerve ablation procedures.
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Affiliation(s)
- Lauren M. Harte
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | - Taylor Rick
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | - Leslie J. Bisson
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | - Stuart Inglis
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | - John M. Marzo
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew YorkUSA
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22
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[Comparison of the effectiveness of the long head of the biceps tendon with or without proximal amputation after arthroscopic repair of the rotator cuff]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:845-852. [PMID: 35848181 PMCID: PMC9288905 DOI: 10.7507/1002-1892.202203056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To compare the effectiveness of the long head of the biceps tendon (LHBT) with or without proximal amputation after arthroscopic rotator cuff repair in the treatment of repairable rotator cuff tear with LHBT injury. METHODS The clinical data of 68 patients with LHBT injury combined with supraspinatus tendon tear who met the selection criteria between January 2016 and June 2020 were retrospectively analyzed. According to whether the proximal end of LHBT was cut off or not after arthroscopic rotator cuff repair, they were divided into LHBT fixation without cutting group (group A, 32 cases) and LHBT fixation with cutting group (group B, 36 cases). There was no significant difference in gender, age, operating side, preoperative supraspinatus tear width, Constant-Murley shoulder function scale, University of California Los Angeles (UCLA) score, and visual analogue scale (VAS) score between the two groups ( P>0.05). The operation time, elbow flexion muscle strength, and postoperative complications were compared between the two groups. The Constant-Murley shoulder function scale, UCLA score, and VAS score were used to evaluate the recovery of shoulder function before operation and at 3, 6, 12 months after operation. The acromion-humeral distance (AHD) was measured by Y-view X-ray film of the shoulder joint immediately after operation and at last follow-up. AHD and acromion-greater tubercle distance (AGT) were measured by musculoskeletal ultrasound at 0°, 30°, 60°, and 90° of abduction. RESULTS There was no significant difference in operation time between the two groups ( t=-0.740, P=0.463). Patients in both groups were followed up (13.0±0.7) months in group A and (13.1±0.8) months in group B, with no significant difference ( t=0.127, P=0.899). At last follow-up, the elbow flexor muscle strength of the two groups reached grade Ⅴ. Complications (including shoulder pain, deltoid atrophy, and rotator cuff re-tear) occurred in 6 patients (18.75%) in group A and 9 patients (25.00%) in group B, without neurovascular injury, surgical site infection, joint stiffness, LHBT spasmodic pain, and Popeye deformity. There was no significant difference in the incidence of complications between the two groups ( χ 2=0.385, P=0.535). The Constant-Murley shoulder function scale, UCLA score, and VAS score significantly improved in both groups at 3, 6, and 12 months after operation ( P>0.05). The above scores in group B were significantly better than those in group A at 3 and 6 months after operation ( P<0.05), and there was no significant difference between the two groups at 12 months after operation ( P>0.05). Y-view X-ray film measurement of the shoulder joint showed that the AHD of the two groups at last follow-up was less than that at immediate after operation, but the difference was not significant ( Z=-1.247, P=0.212); the AHD of group A was significantly greater than that of group B at last follow-up ( t=-2.291, P=0.025). During musculoskeletal ultrasound detection of abduction and shoulder lift, there was no significant difference in the reduction degree of AHD and AGT in group A with abduction of 0°-30° compared with group B ( P>0.05). The reduction degree of AHD and AGT in group A with abduction of 30°-60°, and the reduction degree of AGT in group A with abduction of 60°-90° were significantly smaller than those in group B ( P<0.05). CONCLUSION In arthroscopic rotator cuff repair, whether the proximal structure of LHBT is cut off or not after LHBT fixation can effectively improve the symptoms of patients and promote the recovery of shoulder joint function. Compared with preserving the proximal structure of LHBT, cutting the proximal structure of LHBT after LHBT fixation has more obvious pain relief within 6 months, and the latter had better stability above the shoulder joint.
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McDevitt AW, Cleland JA, Addison S, Calderon L, Snodgrass S. Physical Therapy Interventions for the Management of Biceps Tendinopathy: An International Delphi Study. Int J Sports Phys Ther 2022; 17:677-694. [PMID: 35693861 PMCID: PMC9159730 DOI: 10.26603/001c.35256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Shoulder pain related to the long head of the biceps tendon (LHBT) tendinopathy can be debilitating and difficult to treat especially in athletes who often elect for surgical intervention. Conservative management is recommended but there are limited established guidelines on the physical therapy (PT) management of the condition. Hypothesis/Purpose The purpose of this study was to establish consensus on conservative, non-surgical physical therapy interventions for individuals with LHBT tendinopathy using the Delphi method approach. Study Design Delphi Study. Methods Through an iterative process, experts in the PT field rated their agreement with a list of proposed treatment interventions and suggested additional interventions during each round. Agreement was measured using a four-point Likert scale. Descriptive statistics including median and percentage agreement were used to measure agreement. Data analysis at the end of Round III produced, by consensus, a list of PT interventions recommended for the management of individuals with LHBT tendinopathy. Consensus was defined as an a priori cutoff of ≥75% agreement. Results The respondent group included 29 international experts in the PT management of individuals with shoulder pain. At the conclusion of the study 61 interventions were designated as recommended based on consensus amongst experts and 9 interventions were not recommended based on the same criteria, 15 interventions did not achieve consensus. Conclusion There is a lack of well-defined, PT interventions used to treat LHBT tendinopathy. Expert respondents reached consensus on multimodal interventions including exercise, manual therapy and patient education to manage LHBT tendinopathy. Level of Evidence 5.
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Affiliation(s)
- Amy W McDevitt
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus; The University of Newcastle
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Doctor of Physical Therapy Program, Tufts University School of Medicine
| | - Simone Addison
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
| | - Leah Calderon
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
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24
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Rauck RC, Jahandar A, Kontaxis A, Dines DM, Warren RF, Taylor SA, Gulotta LV. The role of the long head of the biceps tendon in posterior shoulder stabilization during forward flexion. J Shoulder Elbow Surg 2022; 31:1254-1260. [PMID: 35066121 DOI: 10.1016/j.jse.2021.12.026] [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] [Received: 10/02/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The role of the long head of the biceps tendon (LHBT) in glenohumeral stability is not fully understood. Most objects are lifted in the sagittal plane with forward flexion, which stresses the posterior aspect of the unconstrained glenohumeral joint. Determining the mechanism by which the shoulder maintains stability with functional motions is important to understanding the pathoanatomy of degenerative shoulders. Our hypothesis was that the LHBT resists posterior translation of the humeral head (HH) during forward flexion by tensioning the posterior capsuloligamentous complex. METHODS Ten fresh-frozen cadaveric shoulders were tested using an established shoulder simulator that loads the LHBT, rotator cuff, and deltoid tendons through a system of pulleys. A motion tracking system recorded glenohumeral translations with an accuracy of ±0.2 mm. In each subject, the scapula was fixed and the humerus was tested in 6 positions: 30° and 60° of glenohumeral forward flexion at (1) maximum internal rotation (IR), (2) neutral rotation, and (3) maximum external rotation (ER). The deltoid was loaded with 100 N, and the infraspinatus and subscapularis were loaded with 22 N each. The difference in glenohumeral translation was calculated at each position comparing the LHBT loaded with 45 N or unloaded. RESULTS At 30° of glenohumeral forward flexion, unloading the LHBT increased HH posterior translation by 2.5 mm (±0.9 mm; P < .001), 1.7 mm (±1.0 mm; P < .001), and 1.0 mm (±0.9 mm; P = .01) at maximum ER, neutral rotation, and maximum IR, respectively. At 60° of glenohumeral forward flexion, unloading the LHBT increased HH posterior translation by 2.8 mm (±1.2 mm; P < .001), 2.4 mm (±1.6 mm; P < .001), and 1.7 mm (±1.4 mm; P < .001) at maximum ER, neutral rotation, and maximum IR, respectively. CONCLUSION LHBT loading resists posterior translation of the HH during forward flexion. These data support the role of the LHBT as a posterior stabilizer of the shoulder, specifically when a person is carrying objects in front of them. Further work is needed to determine if unloading the LHBT, as is done with biceps tenotomy or tenodesis, may eventually lead to posterior labral pathology, or to the posterior glenoid wear commonly seen with osteoarthritis.
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Affiliation(s)
- Ryan C Rauck
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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25
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Jenkins SM, Hwang IM, Del Sol SR, Guzman AJ, Dela Rueda T, McGahan P, Chen J. Subpectoral Biceps Tenodesis Using an All-Suture Anchor. Arthrosc Tech 2022; 11:e555-e562. [PMID: 35493061 PMCID: PMC9051893 DOI: 10.1016/j.eats.2021.12.007] [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: 09/02/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023] Open
Abstract
Long head biceps tendon pathology is a substantial contributor to anterior shoulder pain and often requires surgical intervention to offer a return to normal functionality. Surgical treatment options consist of both open and arthroscopic tenodesis or tenotomy of the long head biceps brachii. Several techniques exist for tenodesis and tenotomy of the biceps, although current debate continues regarding which surgical approach is the optimal intervention for symptomatic bicep pathology. In this technical note, we describe a subpectoral biceps tenodesis of the long head bicep tendon using an all-suture anchor. Our technique offers the advantages of using an all-suture anchor that incorporates a self-tensioning mechanism with direct visualization of the tendon during biceps tenodesis and anchor insertion.
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Affiliation(s)
- Sarah M. Jenkins
- Advanced Orthopedics and Sports Medicine, San Francisco, California,Address correspondence to Sarah M. Jenkins, Advanced Orthopedics and Sports Medicine, 450 Sutter St., Suite 400, San Francisco, CA 94108, U.S.A.
| | - Inga M. Hwang
- Advanced Orthopedics and Sports Medicine, San Francisco, California
| | - Shane Rayos Del Sol
- Advanced Orthopedics and Sports Medicine, San Francisco, California,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Patrick McGahan
- Advanced Orthopedics and Sports Medicine, San Francisco, California
| | - James Chen
- Advanced Orthopedics and Sports Medicine, San Francisco, California
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26
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Lu Y, Agarwalla A, Lavoie-Gagne O, Patel BH, Beletsky A, Nwachukwu BU, Verma NN, Cole BJ, Forsythe B. How Long Does It Take to Achieve Clinically Significant Outcomes After Isolated Biceps Tenodesis? Orthop J Sports Med 2022; 10:23259671221070857. [PMID: 35284582 PMCID: PMC8908395 DOI: 10.1177/23259671221070857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Clinically significant outcomes (CSOs) connect patient-reported outcome measures data to patient-perceived benefit. Although investigators have established threshold values for various CSOs, the timeline to achieve these outcomes after isolated biceps tenodesis (BT) has yet to be defined. Purpose: To define the time-dependent nature of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) achievement after isolated BT. Study Design: Case series; Level of evidence, 4. Methods: The American Shoulder and Elbow Surgeons score (ASES), the Single Assessment Numeric Evaluation, and the Constant-Murley score (CMS) were administered preoperatively and at 6 and 12 months postoperatively to patients undergoing isolated BT between 2014 and 2018 at our institution. Cumulative probabilities for achieving MCID, SCB, and PASS were calculated using Kaplan-Meier survival analysis. Weibull parametric regression evaluated the hazard ratios (HRs) of achieving earlier MCID, SCB, and PASS. Results: Overall cohort (N = 190) achievement rates ranged between 77.8% and 83.2% for MCID, between 42.2% and 80.2% for SCB, and between 59.7% and 62.9% for PASS. Median achievement time was 5.3 to 6.1 months for MCID, 5.9 to 6.4 months for SCB, and 6.07 to 6.1 months for PASS. Multivariate Weibull parametric regression identified older age, male sex, higher body mass index, preoperative thyroid disease, smoking history, and higher preoperative CMS as predictors of delayed CSO achievement (HR, 1.01-6.41), whereas normal tendon on arthroscopy, defined as absence of tenosynovitis or tendon tear on arthroscopy, predicted earlier CSO achievement (HR, 0.19-0.46). Location of tenodesis and worker compensation status did not significantly predict the time to achieve CSOs on multivariate analysis. Conclusion: After isolated BT, patients can expect to attain CSO by 13 months postoperatively, with most patients achieving this between 5 and 8 months. Patients tend to take longer to achieve PASS than MCID and SCB.
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Affiliation(s)
- Yining Lu
- Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Ophelie Lavoie-Gagne
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bhavik H. Patel
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Benedict U. Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Nikhil N. Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J. Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Kim TM, Shin MH, Baek S, Lee DR, Chung SW. Can a Two Simple Stitches Method Provide Secure Fixation Strength in Biceps Tenodesis?: Biomechanical Evaluation of Various Suture Techniques. Clin Orthop Surg 2022; 14:426-433. [PMID: 36061853 PMCID: PMC9393283 DOI: 10.4055/cios21186] [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: 11/03/2021] [Revised: 01/26/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to compare the initial fixation strength between four different suture methods for the long head of the biceps. Methods Forty-eight fresh frozen porcine flexor hallucis longus tendons (mean width at suture site, 8.5 ± 0.9 mm) and phalanx bones were randomly assigned to one of the four arthroscopic biceps tenodesis techniques: simple stitch (SS), mattress suture (MS), lasso-loop (LL), and two simple stitches (2SS). A biceps tenodesis was performed according to the four techniques using all-suture type suture anchors (1.9-mm SUTUREFIX anchor with No. 1 ULTRABRAID sutures). Biomechanical evaluations were performed to test load to failure (N), stiffness (N/mm), stress (N/m2), and mode of failure. Results As for the SS, MS, LL, and 2SS, the mean load to failure was 50.9 ± 14.61 N, 82.3 ± 24.8 N, 116.2 ± 26.7 N, and 130.8 ± 22.5 N (p < 0.001), respectively; mean stiffness was 6.1 ± 1.3 N/mm, 6.7 ± 2.6 N/mm, 7.8 ± 1.4 N/mm, and 8.1 ± 4.2 N/mm, respectively (p = 0.258); and mean stress was 0.7 ± 0.3 N/m2, 1.4 ± 0.8 N/m2, 2.9 ± 0.7 N/m2, and 2.7 ± 0.8 N/m2, respectively (p < 0.001). All the failures happened by the suture cutting through the tendon along its longitudinal fibers. Conclusions Neither the SS nor the MS method was enough to securely fix the biceps tendon with a significantly lower mechanical strength; however, the 2SS method showed similar initial fixation strength as the LL technique.
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Affiliation(s)
- Tae Min Kim
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Myung Ho Shin
- Department of Orthopaedic Surgery, Center for Hand and Elbow Surgery, CM Hospital, Seoul, Korea
| | - Samuel Baek
- Department of Orthopaedic Surgery, Center for Hand and Elbow Surgery, Red Cross Hospital, Seoul, Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, Center for Hand and Elbow Surgery, Konkuk University School of Medicine Hospital, Seoul, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Hand and Elbow Surgery, Konkuk University School of Medicine Hospital, Seoul, Korea
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Clinical Outcomes of Revision Biceps Tenodesis for Failed Long Head of Biceps Surgery: A Systematic Review. Arthroscopy 2021; 37:3529-3536. [PMID: 34023436 DOI: 10.1016/j.arthro.2021.04.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/24/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We summarize the indications, assess the modes of failure, and analyze the clinical and functional outcomes of revision biceps tenodesis after failed primary surgical treatment of long head of biceps (LHB) pathology. METHODS A computerized search of PubMed, EMBASE, and CINAHL databases and manual screening of selected article reference lists was performed in September 2020. Randomized controlled trial, cohort, case-control, and case series studies reporting clinical outcomes of revision biceps tenodesis following failed LHB surgery were eligible. Patient demographics, indications for revision, intraoperative findings, surgical techniques, and patient-reported outcomes were recorded. Functional assessment and pain scores were assessed and summarized as forest plots with means and 95% confidence intervals. RESULTS Five of 465 identified studies met inclusion criteria, encompassing 70 revision biceps tenodesis procedures with mean follow-up of 2.4-6.4 years. The failed index procedure was biceps tenodesis in 62 patients and tenotomy in 8 patients. The most common indications for revision were pain or cramping and rerupture, cited by 4 and 3 articles, respectively. After failed conservative treatment, open subpectoral revision tenodesis was performed with concomitant arthroscopic debridement in 65 of 70 cases. Common intraoperative findings at time of revision were adhesions or scarring (39.0-83.0%), fixation failure (8.7-75.0%), and biceps rupture (17.4-80.0%). Revision tenodesis patients reported good to excellent functional outcomes with improvements in Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons Shoulder, and visual analog scale pain scores, and satisfaction ranged from 88.0 to 100%. All studies demonstrated moderate quality of evidence and risk of bias when critically appraised. CONCLUSION This systematic review of 5 moderate risk of bias studies demonstrated that the most common reasons for revision biceps tenodesis were pain or cramping and rerupture. Open subpectoral revision tenodesis with concomitant arthroscopic debridement provided improvements in functional scores with high patient satisfaction at mid-term follow up. LEVEL OF EVIDENCE IV, Systematic Review of level III and IV investigations.
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Patel BH, Agarwalla A, Lu Y, Ouillette RJ, Forsythe B, Amin NH, Romeo AA, Liu JN. Isolated Biceps Tenodesis and Tenotomy: A Systematic Review of Indications and Patient Satisfaction. Orthopedics 2021; 44:333-340. [PMID: 34618647 DOI: 10.3928/01477447-20211001-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Biceps tenodesis and tenotomy are increasingly being used as treatment options for shoulder pathology, but patient satisfaction remains largely unstudied. A systematic review of the MEDLINE database was conducted to identify clinical outcome studies on isolated biceps tenodesis or tenotomy that reported patient satisfaction. Within the 15 investigations that were included, the indication for tenotomy was rotator cuff pathology, whereas the indication for tenodesis was biceps pathology or type 2 superior labral tear from anterior to posterior. Patients undergoing tenotomy were 13.6 years older than those undergoing tenodesis (P<.001). Patient satisfaction was high following both procedures, at 85.6% following tenotomy and 92.3% following tenodesis. [Orthopedics. 2021;44(6):333-340.].
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30
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Huddleston HP, Kurtzman JS, Gedailovich S, Koehler SM, Aibinder WR. The rate and reporting of fracture after biceps tenodesis: A systematic review. J Orthop 2021; 28:70-85. [PMID: 34880569 PMCID: PMC8633822 DOI: 10.1016/j.jor.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The purpose of this systematic review was to (1) define the cumulative humerus fracture rate after BT and (2) compare how often fracture rate was reported compared to other complications. METHODS A systematic review was performed using the PRISMA guidelines. RESULTS 39 studies reported complications and 30 reported no complications. Of the 39 studies that reported complications, 5 studies reported fracture after BT (n = 669, cumulative incidence of 0.53%). The overall non-fracture complication rate was 12.9%. DISCUSSION Due to the relatively high incidence of fracture, surgeons should ensure that this complication is disclosed to patients undergoing BT.
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Affiliation(s)
- Hailey P. Huddleston
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Joey S. Kurtzman
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Samuel Gedailovich
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Steven M. Koehler
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - William R. Aibinder
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
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31
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Phornphutkul C, Sripongsai R. Impact of shoulder, elbow and forearm position on biceps tendon excursion: A cadaveric study. J Orthop Surg (Hong Kong) 2021; 29:23094990211022675. [PMID: 34121510 DOI: 10.1177/23094990211022675] [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] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This experimental study investigated the long head biceps tendon (LHBT) excursion that occurs at various positions of the upper limb during tendon stabilizing procedures. We hypothesized that shoulder abduction, elbow extension and forearm pronation would maximize the excursion of the LHBT and potential impacts on tendon stabilization. MATERIALS & METHODS Forequarter specimens from 12 fresh frozen cadavers were used in this study. The study was performed at 0° and 30° of shoulder abduction. Elbow position was either 90° of flexion or full extension with the forearm either in full pronation or supination. A total of 14 combinations of positions were studied. A load of 55 N was applied to the distal biceps. The excursion of the proximal part of LHBT was measured for each of the different positions. RESULTS At a shoulder position of 30° of flexion, shoulder abduction of 30° created significantly greater excursion than 0° of shoulder abduction (p < 0.001). Both full extension of the elbow and full pronation of the forearm also showed significant excursion of the tendon when compared to supination (p < 0.001). CONCLUSIONS The position of the shoulder, elbow and forearm has a significant effect on biceps excursion. Thirty degrees of shoulder abduction and 30° of forward flexion with the elbow in full extension and the forearm in full pronation maximizes excursion. CLINICAL RELEVANCE Information about the excursion of the LHBT affected by the position of the upper limb is useful for any biceps tendon stabilizing procedure. During an operation, the position of the upper limb should be monitored in order to maintain a proper anatomic length-tension relationship.
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Affiliation(s)
- Chanakarn Phornphutkul
- Department of Orthopedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - Ratthapol Sripongsai
- Department of Orthopedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
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Increased Load to Failure in Biceps Tenodesis With All-Suture Suture Anchor Compared With Interference Screw: A Cadaveric Biomechanical Study. Arthroscopy 2021; 37:3016-3021. [PMID: 33895306 DOI: 10.1016/j.arthro.2021.03.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/01/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical characteristics of a single radially expanding all-suture anchor with an interference screw for open subpectoral long head of biceps tendon (LHBT) tenodesis. METHODS Eighteen fresh-frozen matched-pair human cadaveric humeri were used for this biomechanical study. The matched pair humeri were randomly assigned into 2 experimental biceps tenodesis groups: conventional interference screw (CIS) or all-suture suture anchor (ASSA). Open subpectoral LHBT tenodesis was then performed and biomechanical testing was performed using a servohydraulic test frame. A preload of 5 N was applied for 2 minutes before cyclic loading. Displacement was recorded at cycle 300 (D300) and cycle 500 (D500) and at ultimate failure. Data recorded included displacement, load to failure, displacement at failure. Paired t test was used for analysis. RESULTS Decreased displacement was observed for the CIS group at D300 (1.67 ± 0.57 mm vs 3.35 ± 2.24 mm; P = .04), D500 (2.00 ± 0.76 mm vs 3.87 ± 2.20 mm; P = .04), and at failure (5.17 ± 3.05 mm vs 10.76 ± 2.66 mm; P < .001). Load to failure was lower in CIS specimens (170 ± 24.5 N vs 217.8 ± 51.54 N; P = .02). Failure in each case was tendon pullout for all CIS specimens; in ASSA 6 specimens failed as the suture pulled through the tendon, 2 specimens failed by suture breakage. No difference in stiffness was observed between the 2 groups (CIS = 98.33 ± 22.98 N/m vs ASSA = 75.94 ± 44.83 N/m; P = .20). CONCLUSIONS Our study found that open subpectoral biceps tenodesis performed with an ASSA construct results in increased load to failure as compared with CIS. However, the CIS did demonstrate decreased displacement as compared to ASSA in this cadaveric biomechanical study. CLINICAL RELEVANCE ASSA and CIS at time zero provide fixation as indicated by the provider intraoperatively for LHBT tenodesis. ASSA, however, does remove less cortical bone than does CIS and therefore produces a smaller stress riser in the proximal humerus. Further testing as to the integrity of ASSA is warranted to determine the integrity of the tenodesis with cyclical loading.
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Keeling LE, Looney AM, Curley AJ, Ehlers CB, Galel AM, Khalafallah YM, Vippa TK, Bryant BJ, Chang ES. Early Versus Delayed Active Range of Motion After Open Subpectoral Biceps Tenodesis. Orthop J Sports Med 2021; 9:23259671211026619. [PMID: 34458384 PMCID: PMC8392820 DOI: 10.1177/23259671211026619] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Little is known regarding the effect of early active elbow range of motion (ROM) protocols on failure rates and outcomes after open subpectoral biceps tenodesis. Hypothesis We hypothesized that patients managed using an early active ROM protocol after open subpectoral biceps tenodesis would demonstrate similar failure rates and functional outcomes compared to patients managed using a traditional delayed active ROM protocol. Study Design Cohort study; Level of evidence, 3. Methods We evaluated 63 patients who underwent open subpectoral biceps tenodesis with unicortical suture button fixation. Based on surgeon preference, 22 patients were managed using an early active motion protocol consisting of no restrictions on elbow flexion or forearm supination, while 41 patients were managed using a delayed motion protocol postoperatively. Primary outcome measures included failure of biceps tenodesis and American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. Secondary outcomes included shoulder and elbow ROM at 6 months postoperatively. Results The mean follow-up for the 63 patients was 24.2 months postoperatively. One patient (2.4%) in the delayed active motion cohort and no patients in the early active motion cohort experienced failure. Final outcome scores as well as 6-month shoulder and elbow ROM indicated excellent functional outcomes, with no significant difference between motion cohorts. The median postoperative ASES scores were 97.99 in the early active motion cohort (mean ± standard deviation [SD], 95.49 ± 7.68) and 95.42 in the delayed motion cohort (mean ± SD, 90.93 ± 16.08), while median postoperative SANE scores were 96 in the early motion cohort (mean ± SD, 94.23 ± 6.68) and 95 in the delayed motion cohort (mean ± SD, 88.39 ± 17.98). Subgroup analysis demonstrated no significant difference in outcome scores based on the performance of concomitant rotator cuff repair or hand dominance. Conclusion Early active ROM after open subpectoral biceps tenodesis with unicortical suture button fixation resulted in low failure rates and excellent clinical outcomes, comparable to the results of patients managed using delayed active ROM protocols. This suggests that patients undergoing open subpectoral biceps tenodesis may be managed using either early or delayed active motion protocols without compromising functional outcome.
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Affiliation(s)
- Laura E Keeling
- Department of Orthopaedics, Georgetown University Hospital, Washington DC, USA
| | - Austin M Looney
- Department of Orthopaedics, Georgetown University Hospital, Washington DC, USA
| | - Andrew J Curley
- Department of Orthopaedics, Georgetown University Hospital, Washington DC, USA
| | - Cooper B Ehlers
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alexandra M Galel
- Department of Orthopaedics, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | | | - Tarun K Vippa
- Department of Orthopaedics, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Brandon J Bryant
- Department of Orthopaedics, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Edward S Chang
- Department of Orthopaedics, Inova Fairfax Hospital, Falls Church, Virginia, USA
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Cabarcas BC, Beletsky A, Liu J, Gowd AK, Manderle BJ, Cohn M, Verma NN. Short-Term Clinical and Return-to-Work Outcomes After Arthroscopic Suprapectoral Onlay Biceps Tenodesis With a Single Suture Anchor. Arthrosc Sports Med Rehabil 2021; 3:e1065-e1076. [PMID: 34430886 PMCID: PMC8365203 DOI: 10.1016/j.asmr.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe short-term outcomes of arthroscopic suprapectoral onlay biceps tenodesis using a single all-suture anchor with respect to validated outcome measures, return to work, objective strength and motion data, and biceps-specific testing. Methods This study describes a consecutive series of patients undergoing arthroscopic suprapectoral onlay biceps tenodesis performed by a single surgeon from January to December 2017. Patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Surgeons questionnaire, visual analog scale, Single Assessment Numeric Evaluation, Veterans RAND 12-Item Health Survey, and 12-Item Short Form survey, and return-to-work survey. Postoperative strength, range of motion, and biceps-specific testing was also performed. Results This study included 50 patients (26 men and 24 women), with an average age (± standard deviation) of 50.1 ± 10.9 years and average final follow-up of 21.3 ± 8.5 months. Among employed patients, 32 (71.1%) returned to work at an average of 4.6 ± 2.3 months. Light-duty workers returned to work at a significantly greater rate (85.7% vs 33.3%, P = .016) and in less time (2.6 ± 2.0 months vs 6.8 ± 4.2 months) than heavy-duty workers. No differences were found between operative and nonoperative sides in the biceps apex distance (P = .636) or range of motion in elbow flexion and extension (P > .9 for both), supination (P = .192), or pronation (P = .343) postoperatively. Strength in elbow flexion (P = .002), as well as shoulder forward elevation (P < .001) and external rotation (P < .001), increased postoperatively. Significant patient-reported improvements were noted in the American Shoulder and Elbow Surgeons score, visual analog scale pain score, Single Assessment Numeric Evaluation score, Constant-Murley score, and Veterans RAND 12-Item Health Survey and 12-Item Short Form physical component scores (P ≤ .001 for all). A postoperative Popeye deformity developed in 5 patients (10%). Conclusions Arthroscopic suprapectoral onlay biceps tenodesis with a single all-suture anchor can provide overall excellent clinical outcomes regarding strength, motion, and validated patient-reported outcome questionnaires. Return to occupational activities may be less predictable and more prolonged for heavy laborers. A small number of patients may experience cosmetic deformity postoperatively. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Brandon C. Cabarcas
- University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
- Address correspondence to Brandon C. Cabarcas, M.D., 5 Tampa General Cir, Ste 710, Tampa, FL 33606, U.S.A.
| | - Alexander Beletsky
- Division of Sport Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Joseph Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Anirudh K. Gowd
- Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - Brandon J. Manderle
- Division of Sport Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Matthew Cohn
- Division of Sport Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Nikhil N. Verma
- Division of Sport Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
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Agarwalla A, Gowd AK, Liu JN, Beck EC, Cole BJ, Yanke AB, Nicholson GP, Romeo AA, Verma NN, Forsythe B. Predicting Patient Satisfaction With Maximal Outcome Improvement After Biceps Tenodesis. Orthopedics 2021; 44:e359-e366. [PMID: 34039198 DOI: 10.3928/01477447-20210414-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The goal of this study was to determine the threshold for achieving maximal outcome improvement (MOI) on the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley (CM) questionnaires that predict satisfaction after isolated biceps tenodesis without concomitant rotator cuff repair. A retrospective analysis of prospectively collected data was performed for patients undergoing isolated biceps tenodesis from 2014 to 2017 at a single institution with minimum 6-month follow-up. Receiver operating characteristic curve analysis was used to determine thresholds for MOI for the ASES, SANE, and CM questionnaires. Stepwise multivariate logistical regression analysis was performed to identify predictors for achieving the threshold for MOI. A total of 123 patients were included in the final analysis. Receiver operating characteristic analysis determined that achieving 43.1%, 62.1%, and 61.4% MOI was the threshold for satisfaction for the ASES, SANE, and CM questionnaires, respectively. Regression analysis showed that concomitant superior labrum anterior-posterior (SLAP) repair was predictive of achieving MOI on the ASES and SANE questionnaires, whereas partial rotator cuff tear was predictive of achieving MOI on the CM questionnaire (P<.05 for both). Further, workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors of achieving MOI on the SANE and CM questionnaires (P<.05 for all). Achieving MOI of 43.1%, 62.1%, and 61.4% is the threshold for satisfaction after biceps tenodesis for the ASES, SANE, and CM questionnaires, respectively. Concomitant SLAP repair was positively predictive of achieving MOI, whereas workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors. [Orthopedics. 2021;44(3):e359-e366.].
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Forlenza EM, Lu Y, Cohn MR, Baker J, Lavoie-Gagne O, Yanke AB, Cole BJ, Verma NN, Forsythe B. Establishing Clinically Significant Outcomes for Patient-Reported Outcomes Measurement Information System After Biceps Tenodesis. Arthroscopy 2021; 37:1731-1739. [PMID: 33450409 DOI: 10.1016/j.arthro.2020.12.236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish thresholds for improvement in patient-reported outcome scores that correspond with clinically significant outcomes (CSOs) including the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive testing (CAT) and pain interference (PIF) CAT after biceps tenodesis (BT) and to assess patient variables that are associated with achieving these outcomes. METHODS After institutional review board approval was obtained, a prospectively maintained institutional database was queried for patients undergoing BT between December 2017 and August 2019. Patients undergoing BT in isolation or BT in conjunction with rotator cuff debridement, SLAP repair, subacromial decompression, or distal clavicle excision were included in the analysis. Anchor- and distribution-based methods were used to calculate the MCID whereas an anchor-based method was used to calculate SCB and the PASS for PROMIS UE CAT and PIF CAT. RESULTS A total of 112 patients (86.8% follow-up) who underwent BT were included for analysis. The MCID, net SCB, absolute SCB, and PASS for PROMIS UE CAT were 4.02, 9.25, 43.4, and 41.1, respectively. The MCID, net SCB, absolute SCB, and PASS for PROMIS PIF CAT were -4.12, -10.7, 52.4, and 52.4, respectively. Higher preoperative UE CAT and PIF CAT scores, preoperative opioid use, depression, and living alone were negative predictors of CSO achievement. Male sex and regular participation in exercise were positive predictors of CSO achievement. CONCLUSIONS Patients with higher preoperative UE scores were less likely to achieve the MCID (odds ratio [OR], 0.84), whereas patients with higher preoperative PIF scores were less likely to achieve absolute SCB and the PASS (OR, 0.83-0.89). Most patients achieved the MCID for PIF CAT (70.5%) and UE CAT (62.5%) at final follow-up. Male sex (OR, 4.38-9.15) and regular exercise participation (OR, 6.45-18.94) positively predicted CSO achievement, whereas preoperative opioid use (OR, 0.06), depression (OR, 0.23), and living alone (OR, 0.90) were negative predictors of CSO achievement. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Yining Lu
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew R Cohn
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - James Baker
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Adam B Yanke
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Rush University Medical Center, Chicago, Illinois, U.S.A..
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Christensen GV, Smith KM, Kawakami J, Chalmers PN. Surgical Management of Superior Labral Tears in Athletes: Focus on Biceps Tenodesis. Open Access J Sports Med 2021; 12:61-71. [PMID: 33981168 PMCID: PMC8107051 DOI: 10.2147/oajsm.s266226] [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: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 01/02/2023] Open
Abstract
Superior labrum anterior-posterior (SLAP) lesions are common in overhead athletes. Though some patients have asymptomatic lesions, many tears cause pain and diminished athletic performance. Accurate diagnosis of SLAP lesions can be challenging as the sensitivity and specificity of both the physical exam and advanced imaging is questionable. Management is also difficult, as treatment can be life-altering or career-ending for many athletes. If first-line nonoperative treatment fails, surgical options may be considered. The optimal surgical management of SLAP lesions in athletes is debated. Historically, return to play (RTP) rates among athletes who have undergone arthroscopic SLAP repair have been unsatisfactory, prompting clinicians to seek alternate surgical options. Biceps tenodesis (BT) has been postulated to eliminate biceps tendon-related pain in the shoulder and is increasingly used as a primary procedure for SLAP lesions. The purpose of this text is to review the current literature on the surgical management of SLAP lesions in athletes with an emphasis on the role of BT.
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Affiliation(s)
- Garrett V Christensen
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Karch M Smith
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Jun Kawakami
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
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van Deurzen DFP, Garssen FL, Wessel RN, Kerkhoffs GMMJ, van den Bekerom MPJ, van Wier MF. The Popeye sign: a doctor's and not a patient's problem. J Shoulder Elbow Surg 2021; 30:969-976. [PMID: 33290851 DOI: 10.1016/j.jse.2020.10.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Popeye sign is a frequently reported finding following long head of the biceps (LHB) surgery and may be more often detected by doctors than by patients. This study investigates agreement between patients and doctors regarding the presence of a Popeye sign following LHB surgery. METHOD This interobserver study investigates agreement between patients and consulting physicians with regard to assessment of a Popeye sign in patients following LHB surgery. Furthermore, this was compared with assessments by non-consulting physicians (observers) using digital photographs of the operated arm, taken both preoperatively and postoperatively. Data about gender, age, and body mass index (BMI) were collected to investigate their role in doctor's reporting of a Popeye sign. Patient's dissatisfaction with a Popeye sign in the operated arm was evaluated as well. RESULTS Ninety-seven patients (mean age 61 ± 6.0 years, 62% male) underwent LHB surgery. A Popeye sign was reported by 2 patients (2%) as opposed to 32 cases (40%) by consulting physicians, of which only 1 case was in agreement. Krippendorff's alpha (Kalpha) for agreement between observers for preoperative photographs was 0.074 (95% CI -0.277, 0.382) and 0.495 (95% CI 0.317, 0.659) for postoperative cases. Kalpha between observers and consulting physicians for pre- and postoperative cases were 0.033 (95% CI -970, 0.642) and 0.499 (95% CI 0.265, 0.699), respectively. Phi coefficient analysis showed a moderate, statistically significant correlation between male sex and Popeye sign identification. Rank-biserial calculation revealed negligible correlation between BMI and age with regard to detecting a Popeye sign by both consulting physicians and observers. Dissatisfaction about swelling in the upper arm was reported in 1 case, though in a location that did not correspond to the location of a Popeye sign. CONCLUSION The Popeye sign is more often identified by doctors than by patients after undergoing LHB surgery. BMI and age are not related to the detection of a Popeye sign, but sex is moderately correlated. Together with the low percentage of dissatisfaction of patients with this swelling, this signifies that a Popeye sign seems to be a doctor's rather than a patient's problem.
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Affiliation(s)
- Derek F P van Deurzen
- Department of Orthopedic Surgery, Shoulder and Elbow Expertise Center, Joint Research, OLVG, Amsterdam, the Netherlands.
| | - Frans L Garssen
- Department of Orthopedic Surgery, Shoulder and Elbow Expertise Center, Joint Research, OLVG, Amsterdam, the Netherlands
| | - Ronald N Wessel
- Department of Orthopedic Surgery, St Antonius ziekenhuis, Utrecht, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Amsterdam, the Netherlands; Academic Center of Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands; International Olympic Committee (IOC) Research Centre of Excellence, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Expertise Center, Joint Research, OLVG, Amsterdam, the Netherlands
| | - Marieke F van Wier
- Department of Orthopedic Surgery, Shoulder and Elbow Expertise Center, Joint Research, OLVG, Amsterdam, the Netherlands
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Bitzer A, Mikula JD, Aziz KT, Best MJ, Nayar SK, Srikumaran U. Diabetes is an independent risk factor for infection after non-arthroplasty shoulder surgery: a national database study. PHYSICIAN SPORTSMED 2021; 49:229-235. [PMID: 32811250 DOI: 10.1080/00913847.2020.1811617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Diabetes has been associated with poor healing and prior literature has shown worse functional outcomes in diabetic patients undergoing both open and arthroscopic shoulder surgery. However, the effects of diabetes on perioperative complications for patients undergoing non-arthroplasty type shoulder procedures are not well defined. The purpose of this study was to analyze the effects of diabetes on 30-day complications following non-arthroplasty shoulder surgery. METHODS The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients who underwent open and arthroscopic shoulder procedures (excluding arthroplasty) from 2011 to 2018. Diabetic patients were identified and compared to a non-diabetic cohort. Demographic data and postoperative complications within 30 days were analyzed. Multivariable regression was used to determine the effect of diabetes on shoulder surgery. RESULTS We identified 99,970 patients who underwent shoulder surgery in our cohort and 13.9% (13,857 patients) of these patients were diabetics. Within the diabetic cohort, 4,394 (31.7%) were insulin dependent. Diabetics were more likely to be older, female, and have a higher body mass index (P < 0.01). Diabetics had a higher rate of associated medial comorbidities (P < 0.05). Diabetics were less likely to be smokers and on average had shorter surgeries (P < 0.05). Univariate analysis showed that diabetes was associated with increased risk for infectious and other major and minor complications; however, multivariate regression revealed that diabetes was only independently associated with infection (OR 1.33, P = 0.38). CONCLUSION While diabetes is associated with increased likelihood of infection following shoulder surgery, absent commonly associated comorbidities, they are not at increased risk for other 30-day postoperative complications.
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Affiliation(s)
- Alexander Bitzer
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jacob D Mikula
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Keith T Aziz
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Suresh K Nayar
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Liu H, Song X, Liu P, Yu H, Zhang Q, Guo W. Clinical Outcomes of Arthroscopic Tenodesis Versus Tenotomy for Long Head of the Biceps Tendon Lesions: A Systematic Review and Meta-analysis of Randomized Clinical Trials and Cohort Studies. Orthop J Sports Med 2021; 9:2325967121993805. [PMID: 33997057 PMCID: PMC8071980 DOI: 10.1177/2325967121993805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background Controversy exists concerning whether tenotomy or tenodesis is the optimal surgical treatment option for proximal biceps tendon lesions. Purpose To evaluate the clinical outcomes after arthroscopic tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed by searching PubMed, the Cochrane Library, Web of Science, and Embase to identify randomized controlled trials (RCTs) and cohort studies that compared the clinical efficacy of tenotomy with that of tenodesis for LHBT lesions. A standardized data extraction form was predesigned to obtain bibliographic information of the study as well as patient, intervention, comparison, and outcome data. A random-effects model was used to pool quantitative data from the primary outcomes. Results A total of 21 eligible studies were separated into 3 methodological groups: (1) 4 RCTs with level 1 evidence, (2) 3 RCTs and 4 prospective cohort studies with level 2 evidence, and (3) 10 retrospective cohort studies with level 3 to 4 evidence. Analysis of the 3 groups demonstrated a significantly higher risk of the Popeye sign after tenotomy versus tenodesis (group 1: risk ratio [RR], 3.29 [95% CI, 1.92-5.49]; group 2: RR, 2.35 [95% CI, 1.43-3.85]; and group 3: RR, 2.57 [95% CI, 1.33-4.98]). Arm cramping pain remained significantly higher after tenotomy only in the retrospective cohort group (RR, 2.17 [95% CI, 1.20-3.95]). The Constant score for tenotomy was significantly worse than that for tenodesis in the prospective cohort group (standardized mean difference [SMD], -0.47 [95% CI, -0.73 to -0.21]), as were the forearm supination strength index (SMD, -0.75 [95% CI, -1.28 to -0.21]) and the Simple Shoulder Test (SST) score (SMD, -0.60 [95% CI, -0.94 to -0.27]). Conclusion The results demonstrated that compared with tenodesis, tenotomy had a higher risk of a Popeye deformity in all 3 study groups; worse functional outcomes in terms of the Constant score, forearm supination strength index, and SST score according to prospective cohort studies; and a higher incidence of arm cramping pain according to retrospective cohort studies.
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Affiliation(s)
- Hongzhi Liu
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Pei Liu
- Henan Luoyang Orthopedic-Traumatological Hospital, Zhengzhou, China
| | - Huachen Yu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.,Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.,Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
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Niemann MJ, Brooks WC, Ghobrial JA, Makani A, Sraj S. Arthroscopic Biceps to Subscapularis Tenodesis: A Surgical Technique. Tech Hand Up Extrem Surg 2021; 26:7-11. [PMID: 33859100 DOI: 10.1097/bth.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A wide variety of techniques are available for tenodesis of the long head of the biceps tendon, and current literature does not favor any one in particular. We present a simple method for arthroscopic soft tissue biceps tenodesis that uses the subscapularis tendon as the anchor. This 5-step technique is time-efficient, technically simple, cost effective, and does not require powered instruments or specialized implants.
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Affiliation(s)
| | | | | | - Ankur Makani
- School of Medicine, West Virginia University, Morgantown, WV
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Hartland AW, Islam R, Teoh KH, Rashid MS. Clinical Effectiveness of Various Surgical Procedures Addressing Long Head of Biceps Pathology: Protocol for a Systematic Review and Meta-Analysis. Int J Surg Protoc 2021; 25:21-25. [PMID: 34013141 PMCID: PMC8114843 DOI: 10.29337/ijsp.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction The long head of biceps tendon is a common source of anterior shoulder pain and impaired function. Multiple surgical procedures are available as treatment options, but the optimal procedure is not known. The aim of this systematic review and meta-analysis is to review the literature to assess the clinical effectiveness of various surgical procedures to treat pain arising from the long head of biceps. Methods The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Electronic databases used for the literature search will include MEDLINE, EMBASE, PsycINFO, and The Cochrane Library. Randomised controlled trials (RCTs) evaluating surgical procedures on the long head of biceps will be included. Our primary outcome is any functional patient-reported outcome measure related to the shoulder. Secondary outcomes will include the rate of 'Popeye' deformity, the rate of biceps cramping pain, the rate of complications, objective measurements of strength testing such as dynamometer, and other patient-reported outcome measures not specific to the shoulder such as the Visual-Analog Scale (VAS) for pain. Methodological quality of included studies will be assessed using The Cochrane Risk of Bias Tool 2.0 and the Jadad score. Inconsistency and bias across included studies will be assessed statistically. Comparable outcome data will be pooled and analysed quantitatively or qualitatively as appropriate. Ethics and dissemination No ethical clearances required for this study. We plan to publish this systematic review and meta-analysis in a peer-reviewed journal. It will also be presented at various national and international conferences. Highlights Evaluating the clinical effectiveness of surgical procedures for long head of biceps pathology.Randomised controlled trials.Biceps tenodesis and biceps tenotomy.Systematic review compliant with the PRISMA guideline.
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Affiliation(s)
| | - Raisa Islam
- Trauma and Orthopaedics, Princess Alexandra Hospital, Hamstel Road, Harlow, Essex, CM20 1QX, UK
| | - Kar H Teoh
- Trauma and Orthopaedics, Princess Alexandra Hospital, Hamstel Road, Harlow, Essex, CM20 1QX, UK
| | - Mustafa S Rashid
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Windmill Road, Oxford, OX3 7LD, UK.,Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
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Frantz TL, Shacklett AG, Martin AS, Barlow JD, Jones GL, Neviaser AS, Cvetanovich GL. Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review. Am J Sports Med 2021; 49:522-528. [PMID: 32579853 DOI: 10.1177/0363546520921177] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years. PURPOSE To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear. STUDY DESIGN Systematic review. METHODS A systematic review was performed for any articles published before July 2019. The search phrase "labral tear" was used to capture maximum results, followed by keyword inclusion of "SLAP tear" and "biceps tenodesis." Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined. RESULTS After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals. CONCLUSION BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.
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Affiliation(s)
- Travis L Frantz
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Andrew G Shacklett
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | | | | | - Grant L Jones
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Andrew S Neviaser
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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Lu Y, Beletsky A, Chahla J, Patel BH, Verma NN, Cole BJ, Forsythe B. How can we define clinically important improvement in pain scores after biceps tenodesis? J Shoulder Elbow Surg 2021; 30:430-438. [PMID: 32593673 DOI: 10.1016/j.jse.2020.05.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient postoperative pain is an important consideration following biceps tenodesis. The visual analog scale (VAS) for pain is one of the most commonly used measures for perioperative pain assessment. Currently, there is limited understanding of clinically significant improvement in VAS pain. PURPOSE To define the substantial clinical benefit (SCB), patient acceptable symptomatic state (PASS), and minimal clinically important difference (MCID) for the VAS pain score in patients undergoing open subpectoral (OSPBT) or arthroscopic suprapectoral biceps tenodesis (ASPBT) at 1 year from surgery; and to identify preoperative predictors of achieving each outcome end point. METHODS Data from consecutive patients who underwent isolated biceps tenodesis between January 2014 and March 2017 were collected and analyzed. Baseline data and postoperative patient-reported outcome (PRO) scores were recorded at 1 year postoperatively. In order to quantify the clinical significance of outcome achievement for the VAS pain score, the MCID, PASS, and SCB were calculated. RESULTS A total of 165 patients were included in the final analysis. The VAS pain score threshold for achieving MCID was defined as a decrease of 12.9 (0-100). PASS was defined as achieving a 2-year postoperative score of 27.4 points (0-100), and SCB was defined as a decrease of 25.1 (0-100) at 1-year follow-up. The rates of achieving MCID, PASS, and SCB were 73.3%, 52.8%, and 45.9%, respectively. Multivariate regression analysis demonstrated that ASPBT (P = .01) and a lower preoperative Constant-Murley score were predictive of achieving the MCID (P = .01). In contrast, a lower preoperative score on the SF-12 Physical Component Summary (P = .01) and a higher score on the preoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (P < .001) were predictive of achieving the SCB and PASS, respectively. Preoperative duration of symptoms >6 months was predictive of a reduced likelihood to achieve PASS. CONCLUSION This study identified scores for VAS pain that can be used to define clinically significant outcome after biceps tenodesis. Specifically, a decrease in pain score of 12.9 was a clinically important improvement in VAS pain, whereas a decrease of 25.1 represented the upper threshold of VAS pain improvement. Additionally, there were both modifiable and nonmodifiable factors that predicted achieving clinically significant levels of postoperative pain improvement.
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Affiliation(s)
- Yining Lu
- Department of Orthopaedics and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alexander Beletsky
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Jorge Chahla
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Bhavik H Patel
- Department of Orthopaedics, University of Illinois College of Medicine, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Lu Y, Agarwalla A, Patel BH, Nolte MT, Cancienne J, Verma N, Cole BJ, Forsythe B. Influence of workers' compensation status on postoperative outcomes in patients following biceps tenodesis: a matched-pair cohort analysis. J Shoulder Elbow Surg 2020; 29:2530-2537. [PMID: 33190754 DOI: 10.1016/j.jse.2020.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although the literature on the association of workers' compensation (WC) status with negative outcomes after orthopedic surgery is extensive, there is a paucity of evidence on outcomes in WC recipients undergoing biceps tenodesis. We hypothesized that WC patients would report significantly worse outcomes postoperatively on patient-reported outcome measures (PROMs). METHODS Functional and health-related quality-of-life PROMs and a visual analog scale score for pain were administered preoperatively and at 12 months postoperatively to consecutive patients undergoing isolated biceps tenodesis between 2014 and 2018 at our institution. Thirty-eight WC patients were matched 1:2 to non-WC patients by age, body mass index, and operative limb. The minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state were calculated for all patients via anchor- and distribution-based methods. Rates of achievement and the likelihood of achievement were determined. RESULTS All patients showed significant improvements in all outcome measures (P < .001). WC patients reported inferior postoperative scores on all PROMs examined. WC status significantly predicted a reduced likelihood of achieving substantial clinical benefit for the American Shoulder and Elbow Surgeons score (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.17-0.81; P = .01) and the patient acceptable symptom state (OR, 0.28; 95% CI, 0.12-0.65; P = .003) for the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score (OR, 0.24; 95% CI, 0.10-0.61; P = .003), Constant-Murley Subjective Assessment (OR, 0.25; 95% CI, 0.08-0.77; P = .016), and visual analog scale pain score (OR, 0.27; 95% CI, 0.16-0.47; P < .001). CONCLUSION WC patients reported inferior scores on all postoperative PROMs and demonstrated lower odds of achieving substantial benefit and satisfaction regarding improvements in both function and pain compared with non-WC patients.
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Affiliation(s)
- Yining Lu
- Department of Orthopaedics, Mayo Clinic, Rochester, MN, USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Bhavik H Patel
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Michael T Nolte
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Jourdan Cancienne
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Agarwalla A, Lu Y, Chang E, Patel BH, Cancienne JM, Cole BJ, Verma N, Forsythe B. Influence of mental health on postoperative outcomes in patients following biceps tenodesis. J Shoulder Elbow Surg 2020; 29:2248-2256. [PMID: 32684282 DOI: 10.1016/j.jse.2020.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the relationship between preoperative mental health measured by the Short-Form 12 health survey mental component score and outcomes after isolated biceps tenodesis. METHODS The American Shoulder and Elbow Surgeons form (ASES), Single Assessment Numeric Evaluation (SANE), Constant-Murley score (CMS), and visual analog scale (VAS) for pain were administered preoperatively and at 6 and 12 months postoperatively to consecutive patients undergoing isolated biceps tenodesis between 2014 and 2018. Minimal clinically important difference, substantial clinical benefit (SCB), patient-acceptable symptom state (PASS), and rates of achievement were calculated. Patients were stratified by mental health status based on preoperative scores on the Short-Form 12 health survey mental component score. Multivariate logistic regression was performed to evaluate preoperative mental health status on achievement of minimal clinically important difference, SCB, and PASS. RESULTS Patients demonstrated significant improvements in all outcome measures (P < .001). Patients with depression reported inferior postoperative scores on all patient-reported outcome measures. Low preoperative mental health score significantly predicted reduced likelihood to achieve SCB (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.17-0.81, P = .01) and PASS (OR: 0.28, 95% CI: 0.12-0.65, P = .003) on the ASES form, SANE (OR: 0.24, 95% CI: 0.10-0.61, P = .003), CMS (OR: 0.25, 95% CI: 0.08-0.77, P = .016), and VAS pain (OR: 0.01, 95% CI: 0.00-0.31, P = .008). CONCLUSION Patients with depression reported inferior scores on all postoperative patient-reported outcome measures and demonstrated lower odds of achieving the SCB and PASS on the ASES form and PASS on the SANE, CMS, and VAS pain, compared with nondepressed patients.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Chang
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Bhavik H Patel
- Department of Orthopaedic Surgery, University of Illinois, Chicago, IL, USA
| | | | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Hong CK, Su WR, Kuan FC, Chen Y, Chiang CH, Hsu KL. High-Tensile Strength Tapes Show Greater Ultimate Failure Load and Less Stiffness Than High-Tensile Strength Sutures in a Subpectoral Biceps Tenodesis Porcine Model. Arthrosc Sports Med Rehabil 2020; 2:e795-e801. [PMID: 33376994 PMCID: PMC7754602 DOI: 10.1016/j.asmr.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To compare the biomechanical properties of high-tensile strength tape and a high-tensile strength suture in subpectoral biceps tenodesis using a suture anchor in a porcine tendon model. Methods A total of 24 artificial composite (polymer and glass fiber) humeri and porcine flexor profundus tendons were used. Two types of suture materials, high-tensile strength sutures (group S) and high-tensile strength tapes (group T), were evaluated. After we inserted metallic suture anchors with either 2 sutures or tapes 5 cm from the superomedial corner of the greater tuberosity, a Krackow suture technique was used to secure the tendons. After a preload of 5 N for 2 minutes, a cyclic loading test from 5 to 70 N was conducted for 500 cycles. Finally, the specimen was loaded to failure at a rate of 1 mm/s. Results There were no significant between-group differences in elongation after cyclic loading and elongation at failure load for group S and group T (P = .977 and .630, respectively). The ultimate failure loads in group T (278.2 ± 54 N) were significantly greater than those in group S (249.4 ± 32 N) (P = .028). In contrast, the stiffness values in group T (28.5 ± 4.0 N/mm) were significantly lower than those in group S (32.3 ± 4.5 N) (P = .028). Ten specimens in group S and 8 specimens in group T failed, with tendons being cut through by the sutures, whereas the other 2 specimens in group S and 4 specimens in group T failed due to suture breakage. Conclusions Using high-tensile strength tapes in subpectoral biceps tenodesis using a suture anchor leads to significantly greater ultimate failure load as compared with using high-tensile strength sutures in a porcine model. Although lower levels of stiffness were found in high-tensile strength tape group, the difference in the means were not large between 2 groups. Clinical Relevance A strong suture–tendon structure may prevent clinical failure of a subpectoral biceps tenodesis using a suture anchor.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Hospital, Tainan
| | - Chen-Hao Chiang
- Department of Orthopaedic Surgery, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan
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Lamplot JD, Ward BE, O'Brien SJ, Gulotta LV, Taylor SA. Physiologic Long Head Biceps Tendon Excursion Throughout Shoulder Range of Motion: A Cadaveric Study. Orthop J Sports Med 2020; 8:2325967120957417. [PMID: 33110926 PMCID: PMC7557685 DOI: 10.1177/2325967120957417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Restoration of the long head of the biceps tendon (LHBT) length-tension
relationship is critical in preserving muscle strength and efficiency when
performing biceps tenodesis. While static anatomic landmarks such as the
inferior border of the pectoralis major may be used intraoperatively to
achieve this, shoulder position may affect the excursion of the biceps
tendon and represents another variable to consider. Purpose/Hypothesis: The purpose of this study was to quantitatively evaluate the normal excursion
of LHBT that occurs through a glenohumeral range of motion. We also sought
to determine whether elbow position affects LHBT excursion. We hypothesized
that LHBT excursion will be affected by glenohumeral flexion and extension,
and elbow extension will result in increased excursion at each glenohumeral
position compared with a neutral position. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen specimens underwent a standard approach for
subpectoral biceps tenodesis. The LHBT was identified and tagged with a
radiopaque marker within zone 3 of the bicipital tunnel. A total of 3
K-wires were then drilled into the osseous floor: one at the level of the
marker in the LHBT, one at 1 cm proximal, and a third 1 cm distal. All 3
K-wires were then cut flush with the anterior humeral cortex. The specimens
were next placed into 8 different positions, and the excursion of the LHBT
was measured by referencing the K-wires using static fluoroscopic imaging.
The results were analyzed using 1-way analysis of variance testing followed
by Tukey honestly significant difference testing for pairwise comparison
between each individual position and the reference position. Results: The average total LHBT excursion was 24.4 ± 5.2 mm between the neutral
shoulder position and the other shoulder positions tested. The position of
the LHBT was significantly different in the reference position compared with
each of the other 7 shoulder positions (P < .001).
Additionally, the 2 positions of shoulder extension had different LHBT
excursions when compared with each position of shoulder flexion
(P < .0001). For each shoulder position tested, the
position of the LHBT was not significantly different in elbow flexion
compared with extension. Conclusion: There is approximately 24 mm of LHBT excursion throughout the glenohumeral
range of motion, with significantly different amounts of excursion in
glenohumeral flexion and extension. Elbow position does not significantly
affect LHBT excursion. Positioning the shoulder in extension during biceps
tenodesis may overtension the biceps, while positioning the shoulder in
flexion may undertension the biceps relative to the neutral position.
Further research is needed to identify the optimal shoulder position for
biceps tenodesis. Clinical Relevance: Shoulder positioning is an important consideration in establishing a normal
length-tension relationship during biceps tenodesis. When compared with
flexed shoulder positions, LHBT excursion significantly differs in positions
of extension and in a neutral position.
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Affiliation(s)
- Joseph D Lamplot
- Emory University, Department of Orthopaedics, Atlanta, Georgia, USA
| | - Brian E Ward
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Stephen J O'Brien
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Lawrence V Gulotta
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Samuel A Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Umatani N, Arai R, Kuriyama S, Matsuda S. Anatomic limitations of biceps tenodesis using an interference screw for Asian people: a cadaveric study. JSES Int 2020; 4:422-426. [PMID: 32939462 PMCID: PMC7479053 DOI: 10.1016/j.jseint.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Biceps tenodesis using an interference screw has been commonly performed in clinical practice because of pathologic changes. Especially, the tenodesis distal to the bicipital groove, such as suprapectoral tenodesis (SPT) and subpectoral tenodesis (SBT), has been performed to avoid residual anterior shoulder pain. However, the techniques were developed based on research tested on Western population, and it is unknown whether they are applicable to Asian individuals, who have a smaller humerus than Western. The purpose of this study was to investigate the anatomic limitations of the biceps tenodesis using an interference screw for Asians. Methods We analyzed 22 fixed Japanese cadavers. We measured the length of the suprapectoral tenodesis zone (STZ), which is the area from the distal end of the lesser tuberosity to the proximal border of the insertion of the pectoralis major muscle tendon (PMMT) along the course of the biceps tendon, for the SPT. We also measured the bone tunnel depths (BTDs) for the SPT just distal to the lesser tuberosity along the course of the biceps tendon and, similarly, for the SBT just distal to the PMMT insertion. Finally, we analyzed the sexual differences and correlations of the measured values with the entire humeral length. Results In 9 shoulders (40.9%), the proximal border of the PMMT insertion was attached more proximally than the distal end of the lesser tuberosity, and the length of the STZ was negative. The mean BTDs in the SPT and SBT zones were 19.6 and 14.9 mm, respectively. In 11 shoulders (50%), the BTD in the SBT zone was shorter than 15 mm. The lengths of the STZ or BTDs in the SPT and SBT zones did not show statistical differences between sexes and were not correlated with the entire humeral length. Conclusion Asian patients would have anatomic limitations as follows for the biceps tenodesis regardless of their sex or body size. In anomalous PMMT cases, when the SPT was performed just proximal to the PMMT insertion, the bone tunnel entered into the bicipital groove. On the other hand, when the SPT was performed distal to the lesser tuberosity, a part of the PMMT insertion would be injured. Regarding the SBT, an interference screw with a length of ≥12 mm, which is commonly used in Western countries, is too long for Asians.
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Affiliation(s)
- Naoki Umatani
- Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuzo Arai
- Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
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Deng ZJ, Yin C, Cusano J, Abdul-Rassoul H, Curry EJ, Novikov D, Ma R, Li X. Outcomes and Complications After Primary Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis for Superior Labral Anterior-Posterior Tears or Biceps Abnormalities: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120945322. [PMID: 32923502 PMCID: PMC7457415 DOI: 10.1177/2325967120945322] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/31/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Biceps tenodesis is a surgical treatment for both superior labral
anterior-posterior (SLAP) tears and long head of the biceps tendon (LHBT)
abnormalities. Biceps tenodesis can be performed either above or below the
pectoralis major tendon with arthroscopic or open techniques. Purpose: To analyze the outcomes and complications comparing primary arthroscopic
suprapectoral versus open subpectoral biceps tenodesis for either SLAP tears
or LHBT disorders. Study Design: Systematic review; Level of evidence, 4. Methods: A search strategy based on the PRISMA (Preferred Reporting Items for
Systematic Meta-Analyses) protocol was used to include 18 articles (471
patients) from a total of 974 articles identified. Overall exclusion
criteria included the following: non–English language, non–full text, biceps
tenodesis with concomitant rotator cuff repair, review articles,
meta-analyses, and case reports. Data were extracted and analyzed according
to procedure type and tenodesis location: arthroscopic suprapectoral biceps
tenodesis (295 patients) versus open subpectoral bicepts tenodesis (176
patients). Results: For arthroscopic suprapectoral biceps tenodesis, the weighted mean American
Shoulder and Elbow Surgeons (ASES) score was 90.0 (97 patients) and the
weighted mean Constant score was 88.7 (108 patients); for open subpectoral
biceps tenodesis, the mean ASES score was 91.1 (199 patients) and mean
Constant score was 84.7 (65 patients). Among the 176 patients who underwent
arthroscopic biceps tenodesis, there was an overall complication rate of
9.1%. Among the 295 patients who underwent open biceps tenodesis, there was
an overall complication rate of 13.5%. Both residual pain (5.7% vs 4.7%,
respectively) and Popeye deformity (1.7% vs 1.0%, respectively) rates were
similar between the groups. Open subpectoral biceps tenodesis had higher
reoperation (3.0% vs 0.0%, respectively), wound complication (1.0% vs 0.0%,
respectively), and nerve injury (0.7% vs 0.0%, respectively) rates
postoperatively. A meta-analysis of 3 studies demonstrated that both methods
had similar ASES scores (P = .36) as well as all-cause
complication rates (odds ratio, 0.76 [95% CI, 0.13-4.48]; P
= .26). Conclusion: Patients undergoing arthroscopic suprapectoral biceps tenodesis for either
SLAP tears or LHBT abnormalities had similar outcome scores and complication
rates compared with those undergoing open subpectoral biceps tenodesis.
Additionally, both residual pain and Popeye deformity rates were similar
between the 2 groups.
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Affiliation(s)
- Zi Jun Deng
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Clark Yin
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joseph Cusano
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - David Novikov
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston University School of Public Health, Boston, Massachusetts, USA
| | - Richard Ma
- Missouri Orthopaedic Institute, Columbia, Missouri, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| |
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